Healthcare Provider Details

I. General information

NPI: 1366698854
Provider Name (Legal Business Name): GERVASIO & MARCHESE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PARK BLVD
MASSAPEQUA PARK NY
11762-2740
US

IV. Provider business mailing address

1000 PARK BLVD
MASSAPEQUA PARK NY
11762-2740
US

V. Phone/Fax

Practice location:
  • Phone: 516-799-0550
  • Fax: 516-799-0562
Mailing address:
  • Phone: 516-799-0550
  • Fax: 516-799-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNOO5755
License Number StateNY

VIII. Authorized Official

Name: DR. NICHOLAS A MARCHESE
Title or Position: DOCTOR
Credential: DPM
Phone: 516-799-0550