Provider Demographics
NPI:1720196140
Name:MARCHETTA, LEONARD JOSEPH (R-PA)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:JOSEPH
Last Name:MARCHETTA
Suffix:
Gender:M
Credentials:R-PA
Other - Prefix:MR
Other - First Name:LEONARD
Other - Middle Name:JOSEPH
Other - Last Name:MARCHETTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:R-PA
Mailing Address - Street 1:2 JOHANNA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3632
Mailing Address - Country:US
Mailing Address - Phone:917-837-2137
Mailing Address - Fax:
Practice Address - Street 1:5405 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5241
Practice Address - Country:US
Practice Address - Phone:718-948-5475
Practice Address - Fax:718-948-5479
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant