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General NPI Number Information
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NPI Number | 1467562645
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Entity Type | Individual
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Provider Name | MORISA J MARIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 48 ROUTE 25A STE 207
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City | SMITHTOWN
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State | NY
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Zip | 11787-1448
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Country | US
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Telephone | 631-862-3800
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Fax | 631-265-5520
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Provider Business Mailing Address
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Address Line | 222 E MIDDLE COUNTRY RD STE 210
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City | SMITHTOWN
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State | NY
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Zip | 11787-2814
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Country | US
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Telephone | 631-775-3290
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Fax | 631-775-3299
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 172935
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License Number State | NY
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