Healthcare Provider Details

I. General information

NPI: 1073433819
Provider Name (Legal Business Name): MARJAN PERSUH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BROAD ST FL 3
NEW YORK NY
10004-2298
US

IV. Provider business mailing address

2620 29TH ST APT 1
ASTORIA NY
11102-2159
US

V. Phone/Fax

Practice location:
  • Phone: 646-449-0491
  • Fax:
Mailing address:
  • Phone: 917-270-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: