Provider Demographics
NPI:1538429568
Name:ENGELHARDT, MARCIA (RN, PNP)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:ENGELHARDT
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOWNING ST
Mailing Address - Street 2:5W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4734
Mailing Address - Country:US
Mailing Address - Phone:212-675-1879
Mailing Address - Fax:
Practice Address - Street 1:10 DOWNING ST
Practice Address - Street 2:5W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4734
Practice Address - Country:US
Practice Address - Phone:212-675-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380109364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY380109OtherSTATE LICENSE