Provider Demographics
NPI:1639158769
Name:PARISI, MARYBETH (MD)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:PARISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RYKOWSKI LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4018
Mailing Address - Country:US
Mailing Address - Phone:845-692-3376
Mailing Address - Fax:845-692-0124
Practice Address - Street 1:28 RYKOWSKI LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4018
Practice Address - Country:US
Practice Address - Phone:845-692-3376
Practice Address - Fax:845-692-0124
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216253-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11U151Medicare ID - Type Unspecified
NYH60035Medicare UPIN