Provider Demographics
NPI:1427447366
Name:RONDINELLI, MARIETTA
Entity type:Individual
Prefix:MRS
First Name:MARIETTA
Middle Name:
Last Name:RONDINELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 GLENN RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4907
Mailing Address - Country:US
Mailing Address - Phone:718-370-1754
Mailing Address - Fax:
Practice Address - Street 1:121 MCCLEAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4655
Practice Address - Country:US
Practice Address - Phone:718-447-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist