Provider Demographics
NPI:1215731096
Name:MGM PROFESSIONAL CARE SERVICES LLC.
Entity type:Organization
Organization Name:MGM PROFESSIONAL CARE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MARCELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC, CLC
Authorized Official - Phone:646-416-3820
Mailing Address - Street 1:134 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1538
Mailing Address - Country:US
Mailing Address - Phone:646-416-3820
Mailing Address - Fax:
Practice Address - Street 1:134 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1538
Practice Address - Country:US
Practice Address - Phone:646-416-3820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty