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

Marisa Formica, MD

Individual provider Family Medicine Physician · NPI 1568759041

Marisa Formica, MD is a Family Practice in Glen Cove, New York. Qualified in 2009, 17 years ago. Practices with Mm Medical Service PC, a 4-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
17
Licensed in
NY
In the registry since
2011
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

101 Saint Andrews Ln
Glen Cove, NY 11542-2254
Phone: (516) 674-7631
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X · Licence 280850 (NY)
Family Medicine Physician Taxonomy 207Q00000X · Licence 280850 (NY)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1568759041
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 5, 2011
Last updated in NPPESJanuary 16, 2026
Certification dateJanuary 16, 2026
Mailing address101 Saint Andrews Ln, Glen Cove, NY 11542-2254

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Mm Medical Service Pc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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