Provider Demographics
NPI:1023651650
Name:MARUSZEWSKI, MARK JEFFREY
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JEFFREY
Last Name:MARUSZEWSKI
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 1:21 OTSDAWA AVE
Mailing Address - Street 2:
Mailing Address - City:OTEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13825-2260
Mailing Address - Country:US
Mailing Address - Phone:607-434-8442
Mailing Address - Fax:
Practice Address - Street 1:21 OTSDAWA AVE
Practice Address - Street 2:
Practice Address - City:OTEGO
Practice Address - State:NY
Practice Address - Zip Code:13825-2260
Practice Address - Country:US
Practice Address - Phone:607-434-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer