Provider Demographics
NPI:1942452305
Name:MARINO CARROZZO, CATHERINE (DDS)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MARINO CARROZZO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2946
Mailing Address - Country:US
Mailing Address - Phone:516-767-8646
Mailing Address - Fax:516-734-0000
Practice Address - Street 1:14 MAPLE ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2946
Practice Address - Country:US
Practice Address - Phone:516-767-8646
Practice Address - Fax:516-734-0000
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice