Provider Demographics
NPI:1659332377
Name:SANTOS, MARISSA T (MD)
Entity Type:Individual
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First Name:MARISSA
Middle Name:T
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6914 41ST AVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4028
Mailing Address - Country:US
Mailing Address - Phone:718-478-5600
Mailing Address - Fax:718-478-5335
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:SUITE CB
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-478-5600
Practice Address - Fax:718-478-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-06-22
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Provider Licenses
StateLicense IDTaxonomies
NY198043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0403354OtherUNITED HEALTHCARE HMO
NY1531786OtherUNITED HEALTHCARE
NY470858484Other1199NATIONAL BENEFIT FUND
NY01833536Medicaid
NY2592255OtherGHI
NY113380648SA01OtherCARE PLUS HEALTH PLAN
NY198043OtherHIP HEALTH PLAN OF NY
NY198043B27OtherHEALTH FIRST
NY41124OtherCORPORATE BEN SVC AMERICA
NY0166AF1OtherEMPIRE BCBS WOODSIDE
NY040426017706OtherFIDELIS
NY1P1113OtherHEALTH NET
NY5816203OtherAETNA USHC
NY8433171OtherCIGNA HEALTHCARE
NYSM8043OtherAFFINITY HEALTH PLAN
NY172917OtherELDERPLAN
NY11P8501OtherNY PRESBYTERIAN
NYP384086OtherOXFORD HEALTH PLANS
NY470858484Other1199NATIONAL BENEFIT FUND