STATEN ISLAND MEDICAL PRACTICE, P.C.
Ambulatory Health at Hylan Blvd, Staten Island, NY

License number
New York 191751
Category
Ambulatory Health
Type
Primary Care
Owner
Name: MR. LEONARD J MARCHETTA RPA
Title: PHYSICIANS' ASSISTANT
Phone: (718) 948-5475
Address
Address
5405 Hylan Blvd, Staten Island, NY 10312
National Provider ID: 1104142082
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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STATEN ISLAND MEDICAL PRACTICE, PC

Staten Island, NY

Status:
Inactive
Industry:
Health/Allied Services
Doing business as:
Staten Island Medical Practice
Registration:
Jan 7, 2010
Addresses:
5045 Hylan Blvd, Staten Island, NY 10312 (Physical)
5405 Hylan Blvd, Staten Island, NY 10312
State ID:
3896414
Business type:
Domestic Professional Corporation
Internal Medicine, Owners:
Leonard J. Marchetta Physician Assistant, Physicians' Assistant, Principal, inactive,E. Patty Gordon Internal Medicine, Owner, inactive,Edwin Barry Gordon Internal Medicine, Owner, inactive

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