Provider Demographics
NPI:1720415540
Name:FERRIN, MARIANO
Entity type:Individual
Prefix:
First Name:MARIANO
Middle Name:
Last Name:FERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BANK ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1222
Mailing Address - Country:US
Mailing Address - Phone:845-541-9776
Mailing Address - Fax:
Practice Address - Street 1:4 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1222
Practice Address - Country:US
Practice Address - Phone:914-663-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator