Healthcare Provider Details

I. General information

NPI: 1750867792
Provider Name (Legal Business Name): MARISSA LYNN SALTZMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 ATLANTIC AVE
BROOKLYN NY
11217-1702
US

IV. Provider business mailing address

ADVANTAGECARE PHYSICIANS, PC 55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-6300
  • Fax: 718-858-0145
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: