Provider Demographics
NPI:1205808904
Name:MASTROPIETRO, MARISA A (MD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:A
Last Name:MASTROPIETRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5453
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5453
Mailing Address - Country:US
Mailing Address - Phone:718-780-3272
Mailing Address - Fax:718-780-3079
Practice Address - Street 1:263 7TH AVE STE 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3693
Practice Address - Country:US
Practice Address - Phone:718-246-8500
Practice Address - Fax:718-246-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231561207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02566329Medicaid
NY711D61Medicare PIN
H51575Medicare UPIN