Healthcare Provider Details

I. General information

NPI: 1295834174
Provider Name (Legal Business Name): JENNIFER MARCUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CLARA MAASS DR
BELLEVILLE NJ
07109
US

IV. Provider business mailing address

P.O. BOX 128
UNION NJ
07083
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax: 908-653-9305
Mailing address:
  • Phone: 866-291-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08056800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: