Provider Demographics
NPI:1902998420
Name:MARINO, CELESTE A (PA)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:A
Last Name:MARINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LAKEVILLE RD
Mailing Address - Street 2:SMITH INSTITUTE OF UROLOGY
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1117
Mailing Address - Country:US
Mailing Address - Phone:516-465-3017
Mailing Address - Fax:516-465-1830
Practice Address - Street 1:450 LAKEVILLE RD
Practice Address - Street 2:SMITH INSTITUTE FOR UROLOGY
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1117
Practice Address - Country:US
Practice Address - Phone:516-734-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant