Provider Demographics
NPI:1215032297
Name:MARRESE, DAMIAN A (DO)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:A
Last Name:MARRESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2340
Mailing Address - Country:US
Mailing Address - Phone:631-283-2430
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:860 MONTAUK HWY
Practice Address - Street 2:#247
Practice Address - City:WATER MILL
Practice Address - State:NY
Practice Address - Zip Code:11976-0247
Practice Address - Country:US
Practice Address - Phone:631-726-6073
Practice Address - Fax:631-726-6076
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY194499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY57802OtherVYTRA
7227893OtherCIGNA
NY7D6021OtherEMPIRE BCBS
NY01837145Medicaid
219464POtherHIP
NYP4391206OtherOXF
NY1377871OtherUHC
NY7D6021OtherEMPIRE BCBS
NY1377871OtherUHC