1245368463 NPI number — MR. MATTHEW MARIANI OTR,BS

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245368463 NPI number — MR. MATTHEW MARIANI OTR,BS

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MARIANI

Provider First Name:

MATTHEW

Provider Middle Name:

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

OTR,BS

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1245368463

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/20/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

115 MAIN ST

Provider Second Line Business Mailing Address:

SUITE#202 2ND FLOOR

Provider Business Mailing Address City Name:

TUCKAHOE

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

10707-2948

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

914-961-1010

Provider Business Mailing Address Fax Number:

914-961-1011

Provider First Line Business Practice Location Address:

115 MAIN ST

Provider Second Line Business Practice Location Address:

SUITE#202

Provider Business Practice Location Address City Name:

TUCKAHOE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10707-2948

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

914-961-1010

Provider Business Practice Location Address Fax Number:

914-961-1011

Provider Enumeration Date:

03/01/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225X00000X , with the licence number:  46TR01128100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225X00000X , with the licence number: 0083021 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0401995 . This is a "AETNA/ORTHONET TUCKAHOE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2343974 . This is a "HUMANA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 264524354 . This is a "FPN MULTIPLAN/DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 272438120 . This is a "HUDSON VALLEY HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02584178 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1251 . This is a "AMIDACARE-GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1372776 . This is a "CIGNA HEALTH PLANS-FACILITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 272438120 . This is a "POMCO COMMERCIAL INSURANCE LINES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0401997 . This is a "US FAMILY/ORTHONET MCLEAN AVENUE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 10494309 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01828702 . This is a "AMERIGROUP MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0401997 . This is a "AETNA/ORTHONET-MCLEAN AVENUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1016396 . This is a "NBCOT-NATIONAL BOARD CERTIFICATION OCCUPATIONAL THERAPY, INC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1245368463-01 . This is a "HHC CHOICES GOLD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 201116700038 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2343974 . This is a "HUMANA DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 264524354 . This is a "POMCO DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 786980 . This is a "OPTUM HEATH PT-FACILITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 828451 . This is a "OPTUM HEALTH PT/OXFORD HEALTH-CHILD/FREEDOM/FAMILY HEALTH/LIBERTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: Q54981 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".