Provider Demographics
NPI:1780973974
Name:MARCUS, MAUREEN KELLY (RN)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:KELLY
Last Name:MARCUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:DEIRDRE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3 RICHMOND PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1340
Mailing Address - Country:US
Mailing Address - Phone:631-271-4482
Mailing Address - Fax:
Practice Address - Street 1:3 RICHMOND PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1340
Practice Address - Country:US
Practice Address - Phone:631-271-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY465844-1163W00000X, 163WA2000X, 163WP0807X, 163WP0809X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WS0200XNursing Service ProvidersRegistered NurseSchool