Individual provider Active NPI

Marissa Gloria Cardillo, MD

  • Pediatrics Physician
  • Corona, NY
National Provider Identifier
1346709193
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
316313 Issued in NY
Practice address
3716 108TH St
Corona, NY 11368-2025
Phone
(718) 651-4000
NPI assigned
Mar 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 316313 NY Primary

Addresses

Primary practice location

3716 108TH St
Corona, NY 11368-2025

Mailing address

3716 108TH St
Corona, NY 11368-2025

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220817002811 NY Practitioner - Pediatric Medicine 4385027762 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Urban Health Plan, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Urban Health Plan, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Urban Health Plan, Inc. Current Accepting new patients

Locations

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

3716 108th St
Corona, NY 11368
Phone (718) 651-4000

3712 108th St
Corona, NY 11368
Phone (718) 639-4107

4510 94th St
Elmhurst, NY 11373
Phone (347) 748-6115

Networks

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

Organizations & group practices 3

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": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1346709193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 108TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 108TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682025",
            "telephone_number": "718-651-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDILLO",
        "first_name": "MARISSA",
        "middle_name": "GLORIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "316313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

Verify at the official NPI Registry.