Marisa Massaro, NP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

342010 Issued in NY

Practice address

2500 Nesconset Hwy BLDG 14
Stony Brook, NY 11790-2555

Phone

(631) 689-6226

Fax

(631) 675-0736

NPI assigned

Jul 12, 2017

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Doughty and Ryzova Medical Group PC

  • Pediatrics Physician
  • Stony Brook, NY
  • NPI 1306394978
  NPD

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1891217774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY BLDG 14",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902555",
            "telephone_number": "631-689-6226",
            "fax_number": "631-675-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY BLDG 14",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902555",
            "telephone_number": "631-689-6226",
            "fax_number": "631-675-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSARO",
        "first_name": "MARISA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "342010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07176034",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Immaculate Hospital
• Lauren Marzolini
• Matthew Gerard Masiello, PA-C
• Maryanna Mason, M.D.
• Zaki Masoud, MD
• Michael Kenneth Masseria, CRNA
• Lyndsay Ellen Massey, MD
• Jimmy K Master, PSYD
• Cecilia North Mastrogiacomo
• Marzuk Masub, MD

• Family Medicine Physician in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.