Provider Demographics
NPI:1780943001
Name:FERRAZZO-WELLER, MARISSA (DO)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:FERRAZZO-WELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N. MIDDLETOWN RD. SUITE 1F
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965
Mailing Address - Country:US
Mailing Address - Phone:845-920-1990
Mailing Address - Fax:845-920-1986
Practice Address - Street 1:6 BRIGHTON RD FL 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1647
Practice Address - Country:US
Practice Address - Phone:973-777-7911
Practice Address - Fax:973-777-5403
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine