Provider Demographics
NPI:1275150898
Name:MARRELLO, CAREY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:MARRELLO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9562 STATE ROUTE #13
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-4940
Mailing Address - Country:US
Mailing Address - Phone:315-245-5029
Mailing Address - Fax:315-245-5056
Practice Address - Street 1:9562 STATE ROUTE #13
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-4940
Practice Address - Country:US
Practice Address - Phone:315-245-5029
Practice Address - Fax:315-245-5056
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189678207RG0300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06317977Medicaid