Provider Demographics
NPI:1235104548
Name:MARCHISELLA, JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MARCHISELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:MARCHISELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3589 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3513
Mailing Address - Country:US
Mailing Address - Phone:718-966-3700
Mailing Address - Fax:718-966-0433
Practice Address - Street 1:3589 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3513
Practice Address - Country:US
Practice Address - Phone:718-966-3700
Practice Address - Fax:718-966-0433
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200939174400000X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBM5565037OtherDEA
NYG58383Medicare UPIN
NY27N181Medicare ID - Type Unspecified