Healthcare Provider Details

I. General information

NPI: 1740819093
Provider Name (Legal Business Name): MARISA GIUSTINIANO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HENRY ST APT 1G
BROOKLYN NY
11201-2554
US

IV. Provider business mailing address

145 HENRY ST APT 1G
BROOKLYN NY
11201-2554
US

V. Phone/Fax

Practice location:
  • Phone: 718-521-2424
  • Fax: 212-404-8069
Mailing address:
  • Phone: 718-521-2424
  • Fax: 212-404-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSN0007320-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: