Healthcare Provider Details

I. General information

NPI: 1962006312
Provider Name (Legal Business Name): MARQUES ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 MAIN ST APT Q
HACKENSACK NJ
07601-5999
US

IV. Provider business mailing address

586 MAIN ST APT Q
HACKENSACK NJ
07601-5999
US

V. Phone/Fax

Practice location:
  • Phone: 917-657-2108
  • Fax:
Mailing address:
  • Phone: 917-657-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: