Provider Demographics
NPI:1962688994
Name:MUSUMECI, MARISSA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANNE
Last Name:MUSUMECI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3419
Mailing Address - Country:US
Mailing Address - Phone:516-848-5446
Mailing Address - Fax:
Practice Address - Street 1:255 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3419
Practice Address - Country:US
Practice Address - Phone:516-848-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse