Marvin Louie Custodio Enerio

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403815 Issued in NY

Practice address

1468 Madison Ave
New York, NY 10029-6508

Phone

(347) 862-8973

NPI assigned

Oct 25, 2021

Last updated

Feb 1, 2022By the provider in NPPES

Sex

Male

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 NY

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bailey House IncGroup PAC ID 4385870203, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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

• Bailey House Inc

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1083820583
  Medicare reassignment Care Compare group NPD
• Housing Works Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1831122977
  Medicare reassignment NPD
• Housing Works Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1407418379
  NPD
• Housing Works Health Services III, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1114950151
  NPD (past)
• Housing Works Health Services III, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1750934436
  NPD (past)

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1952065260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 W 116TH ST APT 2B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100262068",
            "telephone_number": "347-862-8973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "347-862-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENERIO",
        "first_name": "MARVIN LOUIE",
        "middle_name": "CUSTODIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-25",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manuel Enecilla, M.D.
• Nonso Ekene Enekwechi, M.D., M.P.H.
• Energetic Physical Therapy
• Devi G Enerio-Ellant, DPM
• Ivan Serina Enerio
• Lauren Marie Enes, PA-C
• Eneslow Pedorthic Enterprises Inc
• Eneslow Pedorthic Enterprises, Inc. (Eneslow Little Neck LLC)
• Susan S Eng-Ma, P.A.
• Carrie Eng-Mazur, MSN, WHNP-BC

• Psychiatric/Mental Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.