Organization
STATEN ISLAND MEDICAL PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD J MARCHETTA RPA (PHYSICIANS' ASSISTANT)
(718) 948-5475
Entity
Organization
Contact information
Practice address
5405 HYLAN BLVD, STATEN ISLAND, NY 10312-5241
(718) 948-5475
(718) 948-5479
Mailing address
5405 HYLAN BLVD, STATEN ISLAND, NY 10312-5241
(718) 948-5475
(718) 948-5479
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
191751
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01860833
—
NY
01
—
11177655
CAQH
—
Enumeration date
04/16/2010
Last updated
04/16/2010
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