Provider Demographics
NPI:1992389480
Name:RIZZO, MARISSA T (MD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:T
Last Name:RIZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISSA
Other - Middle Name:T
Other - Last Name:AYASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6 MEDICAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1594
Mailing Address - Country:US
Mailing Address - Phone:631-928-7922
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL DR STE D
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1594
Practice Address - Country:US
Practice Address - Phone:631-928-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program