Provider Demographics
NPI:1750867792
Name:SALTZMAN, MARISSA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:SALTZMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ADVANTAGECARE PHYSICIANS, PC
Mailing Address - Street 2:55 WATER STREET 2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:447 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1702
Practice Address - Country:US
Practice Address - Phone:718-858-6300
Practice Address - Fax:718-858-0145
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant