NPIMap

Individual provider Active NPI

Marissa Anne Romano

  • Surgical Physician Assistant
  • Smithtown, NY
National Provider Identifier
1487133575
Registry record updated Jun 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
994 W Jericho Tpke Ste 104
Smithtown, NY 11787-3211
Phone
(631) 543-1440
NPI assigned
Aug 9, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

994 W Jericho Tpke Ste 104
Smithtown, NY 11787-3211

Mailing address

10 Sycamore Ave
Lake Grove, NY 11755-2731
Phone (631) 617-2034

Other practice location 1

101 Hospital Rd
Patchogue, NY 11772-4870
Phone (631) 654-7100

Other practice location 2

100 Nicolls Rd
Stony Brook, NY 11790-3407
Phone (631) 444-7875

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181001002265 NY Practitioner - Physician Assistant 3072864008 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
State University of New York at Stony Brook, School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Hematology
Stonybrook, NY 11794-0001
Phone (631) 444-7643

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Oct 1, 2025 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Oct 1, 2025 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Locations

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656115200000",
    "number": "1487133575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 SYCAMORE AVE",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552731",
            "telephone_number": "631-617-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 W JERICHO TPKE STE 104",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873211",
            "telephone_number": "631-543-1440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Patchogue",
            "state": "NY",
            "postal_code": "117724870",
            "country_code": "US",
            "telephone_number": "631-654-7100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Nicolls Rd",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117903407",
            "country_code": "US",
            "telephone_number": "631-444-7875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROMANO",
        "first_name": "MARISSA",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-09",
        "last_updated": "2022-06-25",
        "certification_date": "2022-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

Verify at the official NPI Registry.