Provider Demographics
NPI:1649308875
Name:MARSALISI, PATRICIA D (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:MARSALISI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7810
Mailing Address - Country:US
Mailing Address - Phone:845-369-3063
Mailing Address - Fax:
Practice Address - Street 1:133 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5614
Practice Address - Country:US
Practice Address - Phone:845-357-5770
Practice Address - Fax:845-357-8263
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199915367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR3A2920Medicare ID - Type Unspecified