Healthcare Provider Details

I. General information

NPI: 1134482565
Provider Name (Legal Business Name): MARCIA ANITA TITUS-PRESCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RECTOR ST
NEW YORK NY
10006-1705
US

IV. Provider business mailing address

2017 SCHENECTADY AVE
BROOKLYN NY
11234-3130
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-3030
  • Fax: 212-385-2380
Mailing address:
  • Phone: 718-677-6235
  • Fax: 718-236-8456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number459265
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number459265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: