Provider Demographics
NPI:1598835795
Name:NACCARATO, MARCELLA T (RNP)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:T
Last Name:NACCARATO
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 VERNON PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2223
Mailing Address - Country:US
Mailing Address - Phone:718-920-5871
Mailing Address - Fax:718-652-5707
Practice Address - Street 1:MMC - FAMILY CARE CENTER
Practice Address - Street 2:3444 KOSSUTH AVENUE 2ND FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380257363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner