Provider Demographics
NPI:1891488094
Name:MARCELLUS REGISITERED PROF NURSE AND NURSE PRACTITIONER IN ADULT HEALT
Entity Type:Organization
Organization Name:MARCELLUS REGISITERED PROF NURSE AND NURSE PRACTITIONER IN ADULT HEALT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:917-916-7871
Mailing Address - Street 1:265 SUNRISE HWY STE 1-726
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4912
Mailing Address - Country:US
Mailing Address - Phone:516-728-0672
Mailing Address - Fax:929-810-3323
Practice Address - Street 1:22 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-7902
Practice Address - Country:US
Practice Address - Phone:516-728-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty