Individual provider Active NPI

Marissa Krystal Senise

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1124508874
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
308901 Issued in NY
Practice address
1 Gustave L Levy PL
New York, NY 10029-6504
Phone
(212) 241-9502
NPI assigned
Aug 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 308901 NY Primary

Addresses

Primary practice location

1 Gustave L Levy PL
New York, NY 10029-6504

Mailing address

61 Closter Rd
Palisades, NY 10964-1528
Phone (201) 835-9632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220208001109 NY Practitioner - Nurse Practitioner 2062805476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

1190 5TH Ave
GP2W
New York, NY 10029-6503
Phone (212) 241-5646

1440 Madison Ave
New York, NY 10029-6508
Phone (212) 241-5646

5 E 98TH St
Cardiothoracic Surgery of Mount Sin
New York, NY 10029-6501
Phone (212) 241-5646

Hospital & facility affiliations

  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
308901NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 12, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 12, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

1468 Madison Ave
Rm 754A
New York, NY 10029

1468 Madison Ave
Fl 7
New York, NY 10029

1470 Madison Ave
Fl 3
New York, NY 10029
Phone (212) 241-2891

150 E 42nd St
New York, NY 10017
Phone (212) 661-8139

1190 5th Ave
#2W
New York, NY 10029
Phone (212) 241-5646

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1124508874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 CLOSTER RD",
            "city": "PALISADES",
            "state": "NY",
            "postal_code": "109641528",
            "telephone_number": "201-835-9632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-241-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SENISE",
        "first_name": "MARISSA",
        "middle_name": "KRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "308901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.