Healthcare Provider Details

I. General information

NPI: 1427014141
Provider Name (Legal Business Name): MR. DAVID J MARCELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 BELLMORE AVE
NORTH BELLMORE NY
11710-5526
US

IV. Provider business mailing address

1811 FREDERICK AVE
MERRICK NY
11566-2911
US

V. Phone/Fax

Practice location:
  • Phone: 516-781-1085
  • Fax: 516-781-1013
Mailing address:
  • Phone: 516-992-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: