Healthcare Provider Details

I. General information

NPI: 1033372354
Provider Name (Legal Business Name): ROBERT VITO MARCHESE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

ONE EDGEWATER STREET 6TH FLOOR
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9158
  • Fax: 718-226-6964
Mailing address:
  • Phone: 718-226-4324
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: