Provider Demographics
NPI:1639918949
Name:MARCO, MICHAEL JOHN III (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:MARCO
Suffix:III
Gender:M
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PASSAIC AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-3526
Mailing Address - Country:US
Mailing Address - Phone:856-818-4020
Mailing Address - Fax:
Practice Address - Street 1:165 PASSAIC AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3526
Practice Address - Country:US
Practice Address - Phone:856-818-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030730363LP0808X
NJ26NJ15040500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health