Provider Demographics
NPI:1336291129
Name:VEZZA, MARCO E (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:E
Last Name:VEZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1032
Mailing Address - Country:US
Mailing Address - Phone:516-277-2340
Mailing Address - Fax:516-277-2342
Practice Address - Street 1:4 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1032
Practice Address - Country:US
Practice Address - Phone:516-621-9463
Practice Address - Fax:516-621-9469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY196403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY76936OtherVYTRA
NY01553497Medicaid
NY2C8097OtherHEALTHNET
NY5504277OtherGHI
NYP831218OtherOXFORD
NY110174446OtherRAILROAD MEDICARE
NYP831218OtherOXFORD
NY76936OtherVYTRA