Provider Demographics
NPI:1992775464
Name:MARCELLO, MICHAEL ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MARCELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5903
Mailing Address - Country:US
Mailing Address - Phone:973-539-9166
Mailing Address - Fax:973-539-9237
Practice Address - Street 1:134 JAMES ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5903
Practice Address - Country:US
Practice Address - Phone:973-539-9166
Practice Address - Fax:973-539-9237
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00155100111N00000X
MA421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
411297Medicare ID - Type Unspecified
T44888Medicare UPIN