MEDICARE: MARCO E VEZZA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	196403	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	110174446	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76936	OTHER	NY	VYTRA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2C8097	OTHER	NY	HEALTHNET
4	5504277	OTHER	NY	GHI
5	P831218	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1336291129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO E VEZZA M.D.

Provider Business Mailing Address
First Line	:	4 MINEOLA AVE
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1032
Country	:	US
Telephone Number	:	516-277-2340
Fax Number	:	516-277-2342

Provider Business Practice Location Address
First Line	:	4 MINEOLA AVE
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1032
Country	:	US
Telephone Number	:	516-621-9463
Fax Number	:	516-621-9469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/05/2012

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Directions to “ MARCO E VEZZA M.D.” Practice Location

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