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General NPI Number Information
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NPI Number | 1215032297
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Entity Type | Individual
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Provider Name | DAMIAN A MARRESE DO
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 860 MONTAUK HWY #247
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City | WATER MILL
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State | NY
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Zip | 11976-0247
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Country | US
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Telephone | 631-726-6073
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Fax | 631-726-6076
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Provider Business Mailing Address
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Address Line | PO BOX 2340
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City | SOUTHAMPTON
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State | NY
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Zip | 11969-2340
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Country | US
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Telephone | 631-283-2430
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Fax | 631-283-7496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 194499
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License Number State | NY
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