Healthcare Provider Details

I. General information

NPI: 1215032297
Provider Name (Legal Business Name): DAMIAN A MARRESE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NOYACK RD BLDG A
SAG HARBOR NY
11963-1931
US

IV. Provider business mailing address

3330 NOYACK RD BLDG A
SAG HARBOR NY
11963-1931
US

V. Phone/Fax

Practice location:
  • Phone: 631-725-2112
  • Fax: 631-725-7180
Mailing address:
  • Phone: 631-725-2112
  • Fax: 631-725-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number194499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: