Healthcare Provider Details

I. General information

NPI: 1205808904
Provider Name (Legal Business Name): MARISA A MASTROPIETRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE STE 3A
BROOKLYN NY
11215-3693
US

IV. Provider business mailing address

PO BOX 5453
NEW YORK NY
10087-5453
US

V. Phone/Fax

Practice location:
  • Phone: 718-246-8500
  • Fax: 718-246-8501
Mailing address:
  • Phone: 718-780-3272
  • Fax: 718-780-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number231561
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number231561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: