Healthcare Provider Details

I. General information

NPI: 1134114192
Provider Name (Legal Business Name): MICHAEL G MARCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 48TH ST
BROOKLYN NY
11219-2918
US

IV. Provider business mailing address

977 48TH ST
BROOKLYN NY
11219-2919
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8260
  • Fax: 718-635-7235
Mailing address:
  • Phone: 718-283-8015
  • Fax: 718-635-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number148903
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number148903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: