Marzjan McLellan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13593 Issued in TN

Practice address

653 Bay Rd
Queensbury, NY 12804-1446

Phone

(518) 761-0176

NPI assigned

Jul 25, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Marzjan Mustafa Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Affinity Rehabilitation LLP

  • Physical Therapy Clinic/Center
  • Dewitt, NY
  • NPI 1346530169
  Medicare reassignment NPD

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

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1629806971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 WILDWOOD DR",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371678216",
            "telephone_number": "615-648-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 BAY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128041446",
            "telephone_number": "518-761-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLELLAN",
        "first_name": "MARZJAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "13593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARZJAN",
            "last_name": "MUSTAFA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sara Katherine McDonald, OTD, OTR/L
• Mary McGovern, M.S.ED., CF-SLP
• Molly McGrath, CASAC-T
• Elizabeth McIntyre, MS CCC-SLP
• Stephanie M McLain, FNP
• Susan McManus, LCSW
• Aimee E McMaster, ACNP
• Paul R McMore, RPH
• Wendy Sue McNeill, LPN
• Sarah McPhillips, OTD, OTR/L

• Physical Therapist in Queensbury, NY
• Providers in Queensbury, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.