Provider Demographics
NPI:1730582800
Name:MARIN, MARCELO (DNP)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:MARIN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2581
Mailing Address - Country:US
Mailing Address - Phone:201-569-1530
Mailing Address - Fax:201-569-6022
Practice Address - Street 1:148 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2581
Practice Address - Country:US
Practice Address - Phone:201-569-1530
Practice Address - Fax:201-569-6022
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00516200363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care