Provider Demographics
NPI:1144337122
Name:MARCELO, JANETTE (MD)
Entity type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:
Last Name:MARCELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANETTE
Other - Middle Name:
Other - Last Name:YAP-MARCELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 DEEPDALE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2302
Mailing Address - Country:US
Mailing Address - Phone:516-528-8502
Mailing Address - Fax:718-446-0727
Practice Address - Street 1:1155 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3040
Practice Address - Country:US
Practice Address - Phone:516-407-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY478197OtherUNITED HEALTHCARE
NYP601994OtherOXFORD
NY00946323Medicaid
NYE45914Medicare UPIN
NY95977Medicare ID - Type Unspecified