Marcellus A Maiatico, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

25MA3497600 Issued in NJ

Practice address

270 South Broadway
Pennsville, NJ 08070

Phone

(856) 678-5449

Fax

(856) 678-3153

NPI assigned

Jul 16, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shields and Shields PC

  • Ophthalmology Physician
  • Philadelphia, PA
  • NPI 1063501526
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266105600000",
    "number": "1508883695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35",
            "address_2": "270 SOUTH BROADWAY",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "08070",
            "telephone_number": "856-678-5449",
            "fax_number": "856-678-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 SOUTH BROADWAY",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "08070",
            "telephone_number": "856-678-5449",
            "fax_number": "856-678-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIATICO",
        "first_name": "MARCELLUS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2010-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "25MA3497600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1695606",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenny Liu-Melita, MA, LMFT
• David Lunsford I
• Ashley M Lyons-Valenti, RN, APN
• Alicia Denise Macintire-Cain, PSY.D.
• Thomas Madej
• Main Street Dental - Pennsville
• Mark Giorno DMD & Associate PA
• Mazzuca Eye and Laser Centers
• Mazzuca Eye and Laser Centers,PA
• Douglas Edward Mazzuca, DO

• Physical Medicine & Rehabilitation Physician in Pennsville, NJ
• Providers in Pennsville, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.