Marissa Lynn Blau, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

019305 Issued in NY

Practice address

510 Broadhollow Rd.
Suite 100
Melville, NY 11747

Phone

(631) 424-3600

Fax

(631) 424-2963

NPI assigned

Dec 15, 2015

Last updated

Sep 23, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Marissa Lynn Blau Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GFAFDD/Endpoint/GFAFDD
• Direct secure messaging: marissarosgaard@nslijmedgr.allscriptsdirect.net

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

{
    "created_epoch": "1450137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1396100582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 BROADHOLLOW RD.",
            "address_2": "SUITE 100",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "11747",
            "telephone_number": "631-424-3600",
            "fax_number": "631-424-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 BROADHOLLOW RD.",
            "address_2": "SUITE 100",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "11747",
            "telephone_number": "631-424-3600",
            "fax_number": "631-424-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAU",
        "first_name": "MARISSA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-15",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "BLAU",
            "middle_name": "LYNN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rehnuma Bhuiyan
• Vincent Biordi
• Ria Bissoon, BCBA, LBA
• Lynette Blades
• Deborah Anne Blau, MA, CCC/SLP
• George Andrew Blednick, PHD
• Joel Block, PH.D.
• Stacey L Blumberg, M.S. CCC-SLP
• Richard Stephen Blume, MD
• Marilyn Blumenthal, PHD

• Physician Assistant in Melville, NY
• Providers in Melville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.