Provider Demographics
NPI:1922016450
Name:ISRAEL, MARISSA BROOKE
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:BROOKE
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARISSA
Other - Middle Name:BROOKE
Other - Last Name:ISRAEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:26 BROADWAY
Mailing Address - Street 2:SUITE 908
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1703
Mailing Address - Country:US
Mailing Address - Phone:212-425-2115
Mailing Address - Fax:212-425-2636
Practice Address - Street 1:399 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2603
Practice Address - Country:US
Practice Address - Phone:201-991-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00604300152W00000X
NYTUV007034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist