Provider Demographics
NPI:1760771687
Name:MARCHESCHI, JACK A (PT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:A
Last Name:MARCHESCHI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8514 SEAWELL SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516
Mailing Address - Country:US
Mailing Address - Phone:919-932-7044
Mailing Address - Fax:
Practice Address - Street 1:225 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10281-1008
Practice Address - Country:US
Practice Address - Phone:212-236-2639
Practice Address - Fax:212-269-2905
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006615-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6840364001OtherCIGNA
NY1376742OtherUNITED HEALTHCARE
NYQ5977OtherBLUE CROSS BLUE SHIELD