Provider Demographics
NPI:1659899268
Name:BOTWINICK, MARISSA LYNNE
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:LYNNE
Last Name:BOTWINICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W 66TH ST APT 17D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6537
Mailing Address - Country:US
Mailing Address - Phone:732-407-1997
Mailing Address - Fax:
Practice Address - Street 1:195 LITTLE ALBANY ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1914
Practice Address - Country:US
Practice Address - Phone:732-235-5437
Practice Address - Fax:732-235-6462
Is Sole Proprietor?:No
Enumeration Date:2017-09-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA114999002080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology