NPIMap

Individual provider Active NPI

Marisa A Rodriguez, PA-C

  • Physician Assistant
  • Flushing, NY
National Provider Identifier
1184646903
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
009575 Issued in NY
Practice address
56-45 Main St
New York Hospital Medical Center of Queen Emergency Dep
Flushing, NY 11355
Phone
(718) 670-1231
Fax
(610) 617-6280
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 009575 NY Primary

Addresses

Primary practice location

56-45 Main St
New York Hospital Medical Center of Queen Emergency Dep
Flushing, NY 11355

Mailing address

PO Box 430
Emergency Practice Plan
Flushing, NY 11352
Phone (610) 668-6491

Other names 1

  • Ms. Marisa A Renna Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
PM Pediatrics of Livingston, PLLC CurrentSince Mar 1, 2020 Accepting new patients
PM Pediatrics of Bayside PLLC Past Accepting new patients
New York Hospital Medical Center of Queens Past Accepting new patients
Night Lite Pediatric Center, LLC Past Accepting new patients
PM Pediatrics of Mamaroneck Past Accepting new patients
PM Pediatrics PC Past Accepting new patients
PM Pediatrics of Selden Past Accepting new patients

Locations

35 South St
Holmdel, NJ 07733
Phone (732) 706-5437

571 W Mount Pleasant Ave
Livingston, NJ 07039
Phone (973) 992-4767

1 Hollow Ln
Ste 301
New Hyde Park, NY 11042
Phone (516) 207-7851

Interoperability endpoints

  • Direct secure messaging: marisa.rodriguez@pmuc.eclinicaldirectplus.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1184646903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "address_2": "EMERGENCY PRACTICE PLAN",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11352",
            "telephone_number": "610-668-6491",
            "fax_number": "610-617-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56-45 MAIN ST",
            "address_2": "NEW YORK HOSPITAL MEDICAL CENTER OF QUEEN EMERGENCY DEP",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11355",
            "telephone_number": "718-670-1231",
            "fax_number": "610-617-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MARISA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "RENNA",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.