Healthcare Provider Details

I. General information

NPI: 1679565295
Provider Name (Legal Business Name): RICHARD W. MARCUS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 WASHINGTON AVE SUITE A
NUTLEY NJ
07110-3934
US

IV. Provider business mailing address

242 WASHINGTON AVE SUITE A
NUTLEY NJ
07110-3934
US

V. Phone/Fax

Practice location:
  • Phone: 973-667-6676
  • Fax: 973-667-6029
Mailing address:
  • Phone: 973-667-6676
  • Fax: 973-667-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier7933401
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. RICHARD W. MARCUS
Title or Position: OWNER
Credential: M.D.
Phone: 973-667-6676