MEDICARE: ANDREA DEMARCO NBC-HWC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach	A-3937207	NY

General Provider Information

NPI Number	:	1396565685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DEMARCO NBC-HWC

Provider Business Mailing Address
First Line	:	PO BOX 26
Second Line	:
City	:	WILLISTON PARK
State	:	NY
Zip	:	11596-0026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 OLD COUNTRY RD STE 1
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-1758
Country	:	US
Telephone Number	:	516-834-2303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2024
Last Update Date	:	10/12/2024

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