Provider Demographics
NPI:1487728119
Name:DEMARCO, JOHN S (RPAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:290 E MAIN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2916
Mailing Address - Country:US
Mailing Address - Phone:631-361-4802
Mailing Address - Fax:631-361-5376
Practice Address - Street 1:290 E MAIN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2916
Practice Address - Country:US
Practice Address - Phone:631-361-4802
Practice Address - Fax:631-361-5376
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP03684Medicare UPIN
NY0F648ZYWX1Medicare PIN
NY0F6481Medicare PIN