MEDICARE: DR. MARISSA RAE MATARRESE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	268664-1	NY
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	268664	NY

General Provider Information

NPI Number	:	1891816740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA RAE MATARRESE MD

Provider Business Mailing Address
First Line	:	60 CLUB RD
Second Line	:	#304
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-4919
Country	:	US
Telephone Number	:	585-746-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 CORNELIA ST
Second Line	:	#103
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2306
Country	:	US
Telephone Number	:	518-562-7771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	09/25/2025

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