Healthcare Provider Details

I. General information

NPI: 1649130121
Provider Name (Legal Business Name): JUDELINE MARCELLO-SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 NOSTRAND AVE
BROOKLYN NY
11210-3037
US

IV. Provider business mailing address

1 RESEARCH RD
RIDGE NY
11961-2701
US

V. Phone/Fax

Practice location:
  • Phone: 855-528-7322
  • Fax:
Mailing address:
  • Phone: 631-751-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312408-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: