Provider Demographics
NPI:1972135044
Name:RODOPOULOS, MARINA ARIS (LPN)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ARIS
Last Name:RODOPOULOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 45TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1301
Mailing Address - Country:US
Mailing Address - Phone:347-456-4528
Mailing Address - Fax:
Practice Address - Street 1:2173 45TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1301
Practice Address - Country:US
Practice Address - Phone:347-456-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336171164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse