Marisa Formica, MD

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

280850 Issued in NY

Practice address

101 Saint Andrews LN
Glen Cove, NY 11542-2254

Phone

(516) 674-7631

NPI assigned

Jul 5, 2011

Last updated

Jan 16, 2026By 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 3

Addresses

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

Specialty

Family Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MM Medical Service PCGroup PAC ID 2466758297, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

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

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.

• MM Medical Service PC

  • Specialist
  • Forest Hills, NY
  • NPI 1104281286
  Medicare reassignment Care Compare group NPD
• City Medical of Upper East Side, PLLC

  dba CityMD Urgent Care

  • Urgent Care Clinic/Center
  • New York, NY
  • NPI 1801277629
  Medicare reassignment NPD
• City Medical of Upper East Side, PLLC

  dba CityMD Urgent Care

  • Urgent Care Clinic/Center
  • New York, NY
  • NPI 1730491945
  NPD
• City Medical of Upper East Side, PLLC

  • Urgent Care Clinic/Center
  • New York, NY
  • NPI 1740913763
  NPD
• Able Orthopedic and Sports Medicine P.C.

  • Orthopaedic Surgery Physician
  • Forest Hill, NY
  • NPI 1265638696
  NPD (past)

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1568759041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SAINT ANDREWS LN",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SAINT ANDREWS LN",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422254",
            "telephone_number": "516-674-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMICA",
        "first_name": "MARISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-05",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "280850",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NY",
            "license": "280850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis Flancbaum, MD
• Valentina Tereza Fleece, D.D.S
• Odalys Flores
• Footcare Services of Lic
• Forest Manor Care Center Inc (Glen Cove Center for Nursing and Rehabilitation)
• Joana Forsea, DDS
• Fortify Medical Devices & Supplies
• Frederick Ruffen
• Frederick Rufrano Mdfacppc
• Cheryl Friedman, LMSW

• Sports Medicine (Family Medicine) Physician in Glen Cove, NY
• Providers in Glen Cove, NY by specialty
• Sports Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.