Provider Demographics
NPI:1194893727
Name:MARESCA, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MARESCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BAKER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1359
Mailing Address - Country:US
Mailing Address - Phone:845-454-1942
Mailing Address - Fax:845-452-4638
Practice Address - Street 1:19 BAKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1359
Practice Address - Country:US
Practice Address - Phone:845-454-1942
Practice Address - Fax:845-452-4638
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219661207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02498593Medicaid
NYH85385Medicare UPIN
NY02498593Medicaid