Provider Demographics
NPI:1366450868
Name:BURRELL, MARLENE R (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:R
Last Name:BURRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:R
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:38 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3900
Mailing Address - Country:US
Mailing Address - Phone:914-450-4818
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVENUE
Practice Address - Street 2:HARLEM HOSPITAL CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-1000
Practice Address - Fax:212-939-8337
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3345161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718312Medicaid
1548G1Medicare ID - Type Unspecified
NY02718312Medicaid