Provider Demographics
NPI:1053750943
Name:MARISCOTES, JUNE LAZARO
Entity type:Individual
Prefix:MR
First Name:JUNE
Middle Name:LAZARO
Last Name:MARISCOTES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VENICIO
Other - Middle Name:LAZARO
Other - Last Name:MARISCOTES
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 ROBINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-3206
Mailing Address - Country:US
Mailing Address - Phone:615-638-5226
Mailing Address - Fax:
Practice Address - Street 1:24 ROBINWOOD DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-3206
Practice Address - Country:US
Practice Address - Phone:615-638-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004226225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant