Provider Demographics
NPI:1427380799
Name:FLEURY, MARISSA (ATC, PA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:FLEURY
Suffix:
Gender:F
Credentials:ATC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:
Practice Address - Street 1:664 STONELEIGH AVE SUITE 300
Practice Address - Street 2:SOMERS ORTHOPEDIC
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67 0018432255A2300X
NY020986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400175968OtherMEDICARE PTAN