Provider Demographics
NPI:1366126807
Name:THORNBURG, MARISA MONTOYA (MS)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:MONTOYA
Last Name:THORNBURG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:52 STEPHENSON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4402
Mailing Address - Country:US
Mailing Address - Phone:310-570-0922
Mailing Address - Fax:
Practice Address - Street 1:600 MAMARONECK AVE STE 110
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1646
Practice Address - Country:US
Practice Address - Phone:914-670-0500
Practice Address - Fax:914-670-0501
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS