Healthcare Provider Details

I. General information

NPI: 1306059217
Provider Name (Legal Business Name): MARISSA HELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE DEPARTMENT OF DERMATOLOGY, NYU HOSPITAL
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

609 ALBANY ST DEPARTMENT OF DERMATOLOGY
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5245
  • Fax:
Mailing address:
  • Phone: 617-638-5500
  • Fax: 617-638-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number233722
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number233909
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: