Provider Demographics
NPI:1376305573
Name:BARBARIA, MARCELLO (NP)
Entity Type:Individual
Prefix:MR
First Name:MARCELLO
Middle Name:
Last Name:BARBARIA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WASHINGTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-8112
Mailing Address - Country:US
Mailing Address - Phone:845-249-2510
Mailing Address - Fax:845-249-2505
Practice Address - Street 1:207 WASHINGTON ST STE 103
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-8112
Practice Address - Country:US
Practice Address - Phone:845-249-2510
Practice Address - Fax:845-249-2505
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353393363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner