Provider Demographics
NPI:1932722097
Name:QUINONES, MARILYN G (PTA)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:G
Last Name:QUINONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:G
Other - Last Name:QUINONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:654 GARDINER TOWN ROAD APT B
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-784-2859
Mailing Address - Fax:
Practice Address - Street 1:1280 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1570
Practice Address - Country:US
Practice Address - Phone:914-271-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008256225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008256OtherMY P.T.A. LICENSE NUMBER