Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 295942 | NY |
Y | 207RX0202X | Medical Oncology | 295942 | NY |
NPI | 1093133589 |
---|---|
Provider Name | Bridget Kelly Marcellino |
First Address | New York, NY 10017-5699 |
Second Address | New York, NY 10029-6504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 09/01/2020 |