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General NPI Number Information
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NPI Number | 1023406972
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Entity Type | Individual
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Provider Name | MARISSA FORTE PA
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Gender | Female
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 5A MEDICAL PARK DR
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City | POMONA
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State | NY
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Zip | 10970-3516
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Country | US
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Telephone | 845-362-0694
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Fax |
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Provider Business Mailing Address
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Address Line | 5205 OVERLOOK CIR
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City | PIERMONT
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State | NY
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Zip | 10968-1294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 018563
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 018563
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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