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Individual

MARISA MASSARO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2500 NESCONSET HWY BLDG 14, STONY BROOK, NY 11790-2555
(631) 689-6226
(631) 675-0736
Mailing address
2500 NESCONSET HWY BLDG 14, STONY BROOK, NY 11790-2555
(631) 689-6226
(631) 675-0736

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
342010
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
07176034
NY
Enumeration date
07/12/2017
Last updated
03/05/2024
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