Provider Demographics
NPI:1518282540
Name:ABRAM, MARISSA DOROTHY LYNN (RN, NPP)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:DOROTHY LYNN
Last Name:ABRAM
Suffix:
Gender:F
Credentials:RN, NPP
Other - Prefix:MRS
Other - First Name:MARISSA
Other - Middle Name:DOROTHY LYNN
Other - Last Name:STANLEY/LEPORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NPP
Mailing Address - Street 1:21 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 VETERANS HWY
Practice Address - Street 2:PHOENIX HOUSE
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-979-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY603709-1163W00000X
NYF401367-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse