Healthcare Provider Details

I. General information

NPI: 1730650235
Provider Name (Legal Business Name): MARCELLE DUBLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2018
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 NEW LOTS AVE
BROOKLYN NY
11207-6408
US

IV. Provider business mailing address

418 NEW LOTS AVE
BROOKLYN NY
11207-6408
US

V. Phone/Fax

Practice location:
  • Phone: 347-661-7612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberAEC1709736
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: