MARISSA AMBER VAN HENNIK PA
NPI 1740213727
Physician Assistant - Medical in Waterbury, CT

Q: What is Marissa Van Hennik's NPI number?

The NPI number for Marissa Van Hennik is 1740213727. It was assigned to this individual provider in the NPPES registry on July 10, 2006.

Q: What is Marissa Van Hennik's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Active since July 10, 2006PECOS EnrolledAccepts Medicare Assignment

56 FRANKLIN ST, WATERBURY, CT 06706(203) 709-6004(203) 709-3700 Get Directions Write a Review

NPPES record last updated: September 12, 2007. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Marissa Amber Van Hennik Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARISSA AMBER VAN HENNIK PA (NPI 1740213727) is an individual medical provider in Waterbury, Connecticut, licensed in Connecticut (001324) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2002).

NPPES Registry Identity

NPI1740213727

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMARISSA AMBER VAN HENNIKCredential: PA

Location Address56 FRANKLIN STWaterbury, CT 06706-1221

Mailing Address56 Franklin St, 3rd FloorWaterbury, CT 06706-1221 · (203) 709-8873 · Fax (203) 709-8689

Phone(203) 709-6004

Fax(203) 709-3700

Sole ProprietorNo

Medical School CMSOtherGraduated 2002

Enumeration DateJuly 10, 2006

Last NPPES UpdateSeptember 12, 2007

✔ NPI 1740213727 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in CT · 001324

56 FRANKLIN ST, Waterbury, CT 06706

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Other Identifiers 1

Medicare UPINP83788CT

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Marissa Amber Van Hennik Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5092776047

PECOS Enrollment IDI20041022000390

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHARIS WIPFLER

Nurse Practitioner (Critical Care Medicine)