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

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, RPA

Title

Physicians' Assistant

Phone

(718) 948-5475

Specialties & licenses 1

Addresses

Other identifiers 2

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11177655",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01860833",
            "state": "NY"
        }
    ],
    "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.