Provider Demographics
NPI:1477006435
Name:SEIDEN, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SEIDEN
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 1:263 RIVENDELL CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5351
Mailing Address - Country:US
Mailing Address - Phone:516-830-1721
Mailing Address - Fax:
Practice Address - Street 1:263 RIVENDELL CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5351
Practice Address - Country:US
Practice Address - Phone:516-830-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1054951161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist