Provider Demographics
NPI:1578730941
Name:MARSELLA, ANGELO CHRISTOPHER (MA,ATC,USAW)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:CHRISTOPHER
Last Name:MARSELLA
Suffix:
Gender:M
Credentials:MA,ATC,USAW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4142
Mailing Address - Country:US
Mailing Address - Phone:718-767-0610
Mailing Address - Fax:
Practice Address - Street 1:2142 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-4142
Practice Address - Country:US
Practice Address - Phone:718-767-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0008912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer