Provider Demographics
NPI:1902167174
Name:MARSICO, GENA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:
Last Name:MARSICO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:GENA
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:2 HILL COURT
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:347-452-9964
Mailing Address - Fax:
Practice Address - Street 1:2 HILL CT
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1583
Practice Address - Country:US
Practice Address - Phone:347-452-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist