| Staten Island Medical Practice, P.c. | |
|
5405 Hylan Blvd Staten Island NY 10312-5241 | |
| (718) 948-5475 | |
| (718) 948-5479 |
| Full Name | Staten Island Medical Practice, P.c. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 5405 Hylan Blvd, Staten Island, New York |
| Authorized Official Name and Position | Leonard J Marchetta (PHYSICIANS' ASSISTANT) |
| Authorized Official Contact | 7189485475 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Staten Island Medical Practice, P.c. 5405 Hylan Blvd Staten Island NY 10312-5241 Ph: (718) 948-5475 | Staten Island Medical Practice, P.c. 5405 Hylan Blvd Staten Island NY 10312-5241 Ph: (718) 948-5475 |
| NPI Number | 1104142082 |
|---|---|
| Provider Enumeration Date | 04/16/2010 |
| Last Update Date | 04/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104142082 | NPI | - | NPPES |
| 11177655 | Other | CAQH | |
| 01860833 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 191751 (New York) | Primary |
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