Individual provider Active NPI

Amanda Marino

  • Speech-Language Pathologist
  • Ronkonkoma, NY
National Provider Identifier
1639865751
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
624 Hawkins Ave
Ronkonkoma, NY 11779-2375
Phone
(631) 240-3579
NPI assigned
Apr 12, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

624 Hawkins Ave
Ronkonkoma, NY 11779-2375

Mailing address

49 Jesse Way
Mount Sinai, NY 11766-2345
Phone (631) 873-5126

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Theralympic Speech Therapy PLLC Single Specialty CurrentSince Nov 1, 2024 Accepting new patients
Andrea E Nomberg Physician PC Single Specialty CurrentSince Nov 1, 2024 Accepting new patients

Locations

400 S Oyster Bay Rd
Ste 102
Hicksville, NY 11801
Phone (516) 595-7550

2330 Union Blvd
Islip, NY 11751
Phone (631) 224-4200

622 Hawkins Ave
Ronkonkoma, NY 11779
Phone (631) 240-3579

624 Hawkins Ave
Ronkonkoma, NY 11779
Phone (631) 240-3579

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1639865751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 JESSE WAY",
            "city": "MOUNT SINAI",
            "state": "NY",
            "postal_code": "117662345",
            "telephone_number": "631-873-5126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 HAWKINS AVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117792375",
            "telephone_number": "631-240-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINO",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-12",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronkonkoma, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.