Provider Demographics
NPI:1093086027
Name:MARCELINO, JOVENCIO DAYAO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOVENCIO
Middle Name:DAYAO
Last Name:MARCELINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WILSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1934
Mailing Address - Country:US
Mailing Address - Phone:732-946-7656
Mailing Address - Fax:
Practice Address - Street 1:20 WILSHIRE WAY
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1934
Practice Address - Country:US
Practice Address - Phone:732-946-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02705700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology