Healthcare Provider Details

I. General information

NPI: 1194842138
Provider Name (Legal Business Name): MARVIN S. HURVICH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401W END AVE 1E
NEW YORK NY
10024-5724
US

IV. Provider business mailing address

400W END AVE 14A
NEW YORK NY
10024-5778
US

V. Phone/Fax

Practice location:
  • Phone: 212-243-2690
  • Fax:
Mailing address:
  • Phone: 212-243-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number68002943
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: