MEDICARE: MS. MARISSA L BIONDOLILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	101976	NY

General Provider Information

NPI Number	:	1821753898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISSA L BIONDOLILLO

Provider Business Mailing Address
First Line	:	2116 DITMAS AVE APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6917
Country	:	US
Telephone Number	:	716-982-4155
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 JERICHO TPKE STE 103
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-1317
Country	:	US
Telephone Number	:	516-399-5373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	01/16/2026

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