Healthcare Provider Details

I. General information

NPI: 1619699329
Provider Name (Legal Business Name): SARAH MARCELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 04/08/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE UNIT 3
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

685 RIVER AVE UNIT 3
LAKEWOOD NJ
08701-5288
US

V. Phone/Fax

Practice location:
  • Phone: 732-486-7373
  • Fax:
Mailing address:
  • Phone: 732-486-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NR23204500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NR23204500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01375400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: