Provider Demographics
NPI:1679522486
Name:MARCILLA, OSCAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:A
Last Name:MARCILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1139
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:973-740-9895
Practice Address - Street 1:651 W MOUNT PLEASANT AVE
Practice Address - Street 2:EMERGENCY MEDICAL ASSOCIATES
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1600
Practice Address - Country:US
Practice Address - Phone:973-740-0607
Practice Address - Fax:973-740-9895
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201575207P00000X
NJ071031207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67824Medicare UPIN