Provider Demographics
NPI:1871475426
Name:MARENGO, TINA MARIE
Entity type:Individual
Prefix:
First Name:TINA MARIE
Middle Name:
Last Name:MARENGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WALT WHITMAN RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8701
Mailing Address - Country:US
Mailing Address - Phone:631-549-0272
Mailing Address - Fax:631-549-0272
Practice Address - Street 1:350 WALT WHITMAN RD UNIT 3
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-8701
Practice Address - Country:US
Practice Address - Phone:631-549-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010287156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician