Provider Demographics
NPI:1326132473
Name:CAVUOTO PETRIZZO, MARIE (MD, MSED)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:CAVUOTO PETRIZZO
Suffix:
Gender:F
Credentials:MD, MSED
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:CAVUOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 HOFSTRA UNIVERSITY # W222
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11549-5000
Mailing Address - Country:US
Mailing Address - Phone:516-463-7476
Mailing Address - Fax:
Practice Address - Street 1:865 NORTHERN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5310
Practice Address - Country:US
Practice Address - Phone:516-622-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2237382080P0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02684022Medicaid
I27713Medicare UPIN
07303Medicare ID - Type Unspecified