Provider Demographics
NPI:1992996912
Name:ROZARIO, MARCEL (NP)
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:ROZARIO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1191
Mailing Address - Country:US
Mailing Address - Phone:585-798-3345
Mailing Address - Fax:585-798-3416
Practice Address - Street 1:100 OHIO ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1191
Practice Address - Country:US
Practice Address - Phone:585-798-3345
Practice Address - Fax:585-798-3416
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430346363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02897749Medicaid
NYP00695581 - RAILROADMedicare PIN
NY02897749Medicaid
NYRB7436/BA0017 GRPMedicare PIN