Marconi Chu-Chu Sackor

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ01407100 Issued in NJ

Practice address

713 S Broad St
Clayton, NJ 08312-2131

Phone

(443) 740-1672

NPI assigned

Jan 2, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• State of New Jersey Omb Centralized Payroll

  • Psychiatric Hospital
  • Hammonton, NJ
  • NPI 1629155502
  Medicare reassignment NPD
• State of New Jersey Omb Centralized Payroll

  • Psychiatric Hospital
  • Morris Plains, NJ
  • NPI 1336221878
  NPD

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

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672617600000",
    "number": "1629781000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 S BROAD ST",
            "city": "CLAYTON",
            "state": "NJ",
            "postal_code": "083122131",
            "telephone_number": "443-740-1672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 S BROAD ST",
            "city": "CLAYTON",
            "state": "NJ",
            "postal_code": "083122131",
            "telephone_number": "443-740-1672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACKOR",
        "first_name": "MARCONI",
        "middle_name": "CHU-CHU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-02",
        "last_updated": "2023-01-02",
        "certification_date": "2022-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01407100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pivot Health & Fitness
• Sheryl Rauscher
• Angela Mary Richman, CRNA
• Rite Aid of New Jersey Inc
• Brandon Russell, ATC
• Alisha Sheppard
• Kayisha Shoultz
• Renee Smallhorne
• Soraya Health Care
• Taras Walter Spivak, O.D.

• Psychiatric/Mental Health Nurse Practitioner in Clayton, NJ
• Providers in Clayton, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; 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.