Healthcare Provider Details

I. General information

NPI: 1679449367
Provider Name (Legal Business Name): SALVATORE MARCHICA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 RIVERSIDE AVE
MERRICK NY
11566-4515
US

IV. Provider business mailing address

2630 RIVERSIDE AVE
MERRICK NY
11566-4515
US

V. Phone/Fax

Practice location:
  • Phone: 718-954-0850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407705
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number803949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: