Provider Demographics
NPI:1841359197
Name:MARSILLO, RICHARD ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MARSILLO
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 1:70 DIVISION AVE
Mailing Address - Street 2:NEW YORK CHIROPRACTIC COLLEGE
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2941
Mailing Address - Country:US
Mailing Address - Phone:516-796-4800
Mailing Address - Fax:
Practice Address - Street 1:70 DIVISION AVE
Practice Address - Street 2:NEW YORK CHIROPRACTIC COLLEGE
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2941
Practice Address - Country:US
Practice Address - Phone:516-796-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006867-1111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOO6867-1OtherLICENSE
NYXOO6867-1OtherLICENSE