Provider Demographics
NPI:1063013258
Name:MARCELIN, IRIS MASSIEL (NP)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:MASSIEL
Last Name:MARCELIN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:MASSIEL
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:418 BROADWAY STE R
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2922
Mailing Address - Country:US
Mailing Address - Phone:646-785-0034
Mailing Address - Fax:
Practice Address - Street 1:100 N BROADWAY
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1254
Practice Address - Country:US
Practice Address - Phone:646-785-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF406304363LP0808X
NY346796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health