Healthcare Provider Details

I. General information

NPI: 1326132473
Provider Name (Legal Business Name): MARIE CAVUOTO PETRIZZO MD, MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE CAVUOTO MD

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 NORTHERN BLVD STE 101
GREAT NECK NY
11021-5310
US

IV. Provider business mailing address

500 HOFSTRA UNIVERSITY # W222
HEMPSTEAD NY
11549-5000
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-5070
  • Fax:
Mailing address:
  • Phone: 516-463-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number223738
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number223738
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: