Provider Demographics
NPI:1104069970
Name:MARINO, KALEIGH A (RPA-C)
Entity type:Individual
Prefix:MS
First Name:KALEIGH
Middle Name:A
Last Name:MARINO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:KALEIGH
Other - Middle Name:
Other - Last Name:CHIMENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:6 JOLUDOW DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3720
Mailing Address - Country:US
Mailing Address - Phone:631-678-7872
Mailing Address - Fax:
Practice Address - Street 1:266 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2640
Practice Address - Country:US
Practice Address - Phone:516-826-7800
Practice Address - Fax:516-826-7836
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant