Healthcare Provider Details

I. General information

NPI: 1750547881
Provider Name (Legal Business Name): MARISSA CARTWRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

800 POLY PL
BROOKLYN NY
11209-7104
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-3766
  • Fax: 718-630-3761
Mailing address:
  • Phone: 718-630-3766
  • Fax: 718-630-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34266
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL34266
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: