Provider Demographics
NPI:1881906766
Name:MARCELLUS, JEAN-JEFFREY (NP)
Entity type:Individual
Prefix:
First Name:JEAN-JEFFREY
Middle Name:
Last Name:MARCELLUS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:JEAN-JEFFREY
Other - Middle Name:
Other - Last Name:MARCELLUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:22 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-7902
Mailing Address - Country:US
Mailing Address - Phone:917-322-1663
Mailing Address - Fax:
Practice Address - Street 1:265 SUNRISE HWY STE 1-726
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4912
Practice Address - Country:US
Practice Address - Phone:516-728-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305892363LA2200X
NY404910363LP0808X
CA95020542363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health