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General NPI Number Information
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NPI Number | 1558002600
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Entity Type | Organization
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Legal Business Name | MARCHESE INTEGRATIVE MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 7303 GRAND AVE
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City | MASPETH
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State | NY
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Zip | 11378-1523
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Country | US
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Telephone | 718-899-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 7303 GRAND AVE
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City | MASPETH
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State | NY
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Zip | 11378-1523
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Country | US
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Telephone | 718-899-5433
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELLEN MARCHESE
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Credential | MD
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Telephone | 917-573-2091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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