Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Marissa Miceli, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1780575852

Marissa Miceli, PHYSICIANASSISTANT is a Physician Assistant in New York, New York. Works from 2 locations. Licensed in New York.

Licensed in
NY
In the registry since
2025

Practice location Address checks out

622 W 168th St
New York, NY 10032-3720
Phone: (212) 305-2500
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5141 Broadway, New York, NY 10034-1159 — (212) 932-4000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 033983 (NY)

Record details

NPI number1780575852
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedJuly 15, 2025
Last updated in NPPESJuly 15, 2025
Certification dateJuly 15, 2025

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