Provider Demographics
NPI:1366698854
Name:GERVASIO & MARCHESE LLP
Entity type:Organization
Organization Name:GERVASIO & MARCHESE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-799-0550
Mailing Address - Street 1:1000 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2740
Mailing Address - Country:US
Mailing Address - Phone:516-799-0550
Mailing Address - Fax:516-799-0562
Practice Address - Street 1:1000 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2740
Practice Address - Country:US
Practice Address - Phone:516-799-0550
Practice Address - Fax:516-799-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5755213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty