Provider Demographics
NPI:1982410122
Name:MAROTTA, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VAN RIPER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1943
Mailing Address - Country:US
Mailing Address - Phone:718-447-0390
Mailing Address - Fax:
Practice Address - Street 1:12 VAN RIPER ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1943
Practice Address - Country:US
Practice Address - Phone:718-447-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1276550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist