Healthcare Provider Details

I. General information

NPI: 1063606929
Provider Name (Legal Business Name): STEFANI P MARCUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MERCER ST APT 34H
NEW YORK NY
10003-6724
US

IV. Provider business mailing address

300 MERCER ST APT 34H
NEW YORK NY
10003-6724
US

V. Phone/Fax

Practice location:
  • Phone: 212-842-2452
  • Fax:
Mailing address:
  • Phone: 212-842-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: