MEDICARE: TALI MARCUS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1043880412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALI MARCUS LLC

Provider Business Mailing Address
First Line	:	52-1 BERGEN RIDGE RD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-7252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	52-1 BERGEN RIDGE RD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-7252
Country	:	US
Telephone Number	:	201-855-6459
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	TALILA MARCUS
Credential	:
Telephone Number	:	201-855-6459

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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