Provider Demographics
NPI:1891354767
Name:POVERMAN, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:POVERMAN
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 1:180 E 111TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2854
Mailing Address - Country:US
Mailing Address - Phone:520-245-5984
Mailing Address - Fax:
Practice Address - Street 1:180 E 111TH ST APT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2854
Practice Address - Country:US
Practice Address - Phone:520-245-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife