MEDICARE: MARCEL JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		NY

General Provider Information

NPI Number	:	1548191067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCEL JOHNSON

Provider Business Mailing Address
First Line	:	3439 BRUCKNER BLVD APT 4D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	694 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-845-2621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ MARCEL JOHNSON ” Practice Location

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