Healthcare Provider Details

I. General information

NPI: 1356068035
Provider Name (Legal Business Name): MARCUS BUZACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 7TH AVE # 18
NEW YORK NY
10018-7604
US

IV. Provider business mailing address

463 7TH AVE # 18
NEW YORK NY
10018-7604
US

V. Phone/Fax

Practice location:
  • Phone: 212-582-9100
  • Fax:
Mailing address:
  • Phone: 212-582-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: