Provider Demographics
NPI:1891990149
Name:MARCELIN, MAGALIE (NP)
Entity Type:Individual
Prefix:
First Name:MAGALIE
Middle Name:
Last Name:MARCELIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAGALIE
Other - Middle Name:
Other - Last Name:POLYCARPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:25327 148TH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2817
Mailing Address - Country:US
Mailing Address - Phone:718-949-3691
Mailing Address - Fax:718-949-2262
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340230363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology