Marathon Healthcare of Prospect

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2304 Issued in CT

Legal business name

MARATHON HEALTHCARE OF PROSPECT

Practice address

25 Royal Crest Dr
Prospect, CT 06712-1486

Phone

(203) 758-2241

Fax

(203) 758-5601

NPI assigned

May 30, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Andrew Czerniewski

Title

Chief Finanical Officer

Phone

(860) 290-7514

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912954330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E RIVER DR",
            "address_2": "RIVERVIEW SQUARE 8TH FLOOR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083288",
            "telephone_number": "860-528-0007",
            "fax_number": "860-528-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 ROYAL CREST DR",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121486",
            "telephone_number": "203-758-2241",
            "fax_number": "203-758-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARATHON HEALTHCARE OF PROSPECT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CZERNIEWSKI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CHIEF FINANICAL OFFICER",
        "authorized_official_telephone_number": "860-290-7514",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• LTC Dental LLP (Brijesh P. Chandwani, DMD)
• Jack Lu, LCSW, MSW
• Toby Lee Macdonald, MSPT
• Arlene Majka
• Suzy Mann, LCSW
• Anthony Charles Marciano Jr., O.D.
• Krisztina Zsuzsanna Mauriz, DNP, NP-C
• Heather McLain, LCSW
• Renika N McLeod-Labissiere, MD
• Sara Marie Miceli, PA-C

• Skilled Nursing Facility in Prospect, CT
• Providers in Prospect, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.