Individual
MARCO JABOLI DACILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGNP-C
Contact information
Practice address
121 E 97TH ST APT 33, NEW YORK, NY 10029-7210
(732) 895-2353
Mailing address
525 E 68TH ST, NEW YORK, NY 10065-4870
(646) 962-8450
(646) 962-0323
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
F309823
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F309823
NY
Other
Enumeration date
08/05/2021
Last updated
05/04/2023
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