Provider Demographics
NPI:1063626760
Name:TARDIO, MARCO FRANCESCO (PA)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:FRANCESCO
Last Name:TARDIO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 STATE ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:SPARROWBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12780-5027
Mailing Address - Country:US
Mailing Address - Phone:347-598-2434
Mailing Address - Fax:
Practice Address - Street 1:10 UNION SQ E
Practice Address - Street 2:PHILLIPS AMBULATORY CENTER SUITE 3M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3314
Practice Address - Country:US
Practice Address - Phone:212-844-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010418363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical