Active NPI
Ryan Marcelino, M.D.
- Pediatric Anesthesiology Physician
- Chicago, IL
National Provider Identifier
1720309339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Anesthesiology Physician
- License
- 036140786
- Practice address
- 225 E Chicago Ave
Chicago, IL 60611 - Phone
- (732) 406-5538
- NPI assigned
- Jun 17, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Anesthesiology Physician | 207LP3000X | 036140786 | IL | Primary |
Addresses
Primary practice location
225 E Chicago Ave
Chicago, IL 60611
Mailing address
225 E Chicago Ave
Box 19
Chicago, IL 60611
Phone (732) 406-5538
Other practice location 1
Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-7097
Phone (631) 444-2754
Other practice location 2
Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-7097
Phone (631) 444-2754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563494400000",
"number": "1720309339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"address_2": "BOX 19",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60611",
"telephone_number": "732-406-5538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60611",
"telephone_number": "732-406-5538"
}
],
"practiceLocations": [
{
"address_1": "Stony Brook University Hospital",
"address_2": "Medical Staff Office T9",
"address_purpose": "LOCATION",
"city": "Stony Brook",
"state": "NY",
"postal_code": "117947097",
"country_code": "US",
"telephone_number": "631-444-2754",
"fax_number": "631-444-6031",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Stony Brook University Hospital",
"address_2": "Medical Staff Office T9",
"address_purpose": "LOCATION",
"city": "Stony Brook",
"state": "NY",
"postal_code": "117947097",
"country_code": "US",
"telephone_number": "631-444-2754",
"fax_number": "631-444-6031",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARCELINO",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-17",
"last_updated": "2019-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "IL",
"license": "036140786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.