MEDICARE: MS. MARISSA JEANNETTE NITTOLY MS, CCC/SLP TSSLD

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1972757086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISSA JEANNETTE NITTOLY MS, CCC/SLP TSSLD

Provider Business Mailing Address
First Line	:	416 W OLIVE ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3128
Country	:	US
Telephone Number	:	516-870-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 W OLIVE ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3128
Country	:	US
Telephone Number	:	516-870-6144
Fax Number	:

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

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	06/25/2016

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