Provider Demographics
NPI:1336225119
Name:INTRONA, MARIO E (DC)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:INTRONA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3826
Mailing Address - Country:US
Mailing Address - Phone:718-356-5560
Mailing Address - Fax:718-966-4766
Practice Address - Street 1:3705 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3826
Practice Address - Country:US
Practice Address - Phone:718-356-5560
Practice Address - Fax:718-966-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0008391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134034104OtherFEDERAL TAX ID
NYX17911Medicare PIN