Staten Island Medical Practice, P.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

191751 Issued in NY

Legal business name

STATEN ISLAND MEDICAL PRACTICE, P.C.

Practice address

5405 Hylan Blvd
Staten Island, NY 10312-5241

Phone

(718) 948-5475

Fax

(718) 948-5479

NPI assigned

Apr 16, 2010

Last updated

Apr 16, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Leonard J Marchetta, RPANPI 1720196140

Title

Physicians' Assistant

Phone

(718) 948-5475

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leonard Joseph Marchetta, R-P.A.

  • Physician Assistant
  • Staten Island, NY
  • NPI 1720196140
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271376000000",
    "number": "1104142082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125241",
            "telephone_number": "718-948-5475",
            "fax_number": "718-948-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125241",
            "telephone_number": "718-948-5475",
            "fax_number": "718-948-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND MEDICAL PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-16",
        "last_updated": "2010-04-16",
        "status": "A",
        "authorized_official_last_name": "MARCHETTA",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIANS' ASSISTANT",
        "authorized_official_telephone_number": "718-948-5475",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "191751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Staten Island Medical & Behavioral PC
• Staten Island Medical Group, PLLC
• Staten Island Medical Intensivist PC
• Staten Island Medical of New York LLC
• Staten Island Medical of New York, LLC
• Staten Island Medical Professional PC
• Staten Island Medical Rehabilitation, P.C.
• Staten Island Medicine PC
• Staten Island Mental Health Counseling PLLC
• Staten Island Mental Health Society

• Primary Care Clinic/Center in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.