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General NPI Number Information
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NPI Number | 1720196140
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Entity Type | Individual
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Provider Name | LEONARD JOSEPH MARCHETTA R-P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 5405 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5241
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Country | US
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Telephone | 718-948-5475
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Fax | 718-948-5479
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Provider Business Mailing Address
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Address Line | 2 JOHANNA LN
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3632
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Country | US
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Telephone | 917-837-2137
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003712
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License Number State | NY
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