Provider Demographics
NPI:1427509843
Name:MARCELLUS, MARTHA GEORGE
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:GEORGE
Last Name:MARCELLUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:GEORGE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY623837-1163WM0705X, 163WN0002X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care