Provider Demographics
NPI:1093808065
Name:MARCHETTI, ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:MARCHETTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ALFRED
Other - Middle Name:PAUL ALLEN
Other - Last Name:MARCHETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE #350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:12 NEWBURYPORT RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-579-9126
Practice Address - Fax:215-579-9126
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05005943L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ019465QP5Medicaid
NY03537991Medicare PIN
NJ019465QP5Medicaid
NY562665Medicare PIN