Provider Demographics
NPI:1780643254
Name:NASSISI, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:NASSISI
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:BOX 1149
Mailing Address - Street 2:ONE GUSTAVE LEVY PLACE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-0101
Mailing Address - Fax:212-426-5083
Practice Address - Street 1:100TH STREET AND MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-0101
Practice Address - Fax:212-426-5083
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1741971207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01588229Medicaid
NY110166627OtherRR MEDICARE
NY45H771Medicare ID - Type Unspecified
NY01588229Medicaid
NY110166627Medicare PIN