Individual
MARISSA CROFUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34 MAPLE ST, NORWALK, CT 06850-3815
(203) 852-2000
Mailing address
34 MAPLE ST, NORWALK, CT 06850-3894
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
023926
NY
363A00000X
Physician Assistant
Primary
5026
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023926
NEW YORK STATE LICENSE
NY
01
—
5026
CONNECTICUT STATE LICENSE
CT
Enumeration date
08/28/2019
Last updated
10/29/2020
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