Provider Demographics
NPI:1306499637
Name:MARZANO, MARYTA (NP)
Entity type:Individual
Prefix:
First Name:MARYTA
Middle Name:
Last Name:MARZANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 N BELLE MEAD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3495
Mailing Address - Country:US
Mailing Address - Phone:631-444-6250
Mailing Address - Fax:631-444-6665
Practice Address - Street 1:181 N BELLE MEAD RD # SUUITE2
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3495
Practice Address - Country:US
Practice Address - Phone:631-444-6250
Practice Address - Fax:631-444-6665
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily