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General NPI Number Information
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NPI Number | 1356905319
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Entity Type | Individual
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Provider Name | MARISA BEALS MD
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Gender | Female
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 09/29/2024
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Provider Practice Location Address
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Address Line | 5520 PARK AVE # WP2-700
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City | TRUMBULL
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State | CT
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Zip | 06611-3463
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Country | US
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Telephone | 203-374-1018
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Fax | 203-396-0699
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Provider Business Mailing Address
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Address Line | PO BOX 22573
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City | NEW YORK
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State | NY
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Zip | 10087-2572
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Country | US
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Telephone | 856-669-6050
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Fax | 856-651-0794
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 77516
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA11776900
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License Number State | NJ
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