Healthcare Provider Details

I. General information

NPI: 1134114655
Provider Name (Legal Business Name): ELLEN S MARMUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 EAST 87TH STREET SUITE 1A
NEW YORK NY
10128-0501
US

IV. Provider business mailing address

12 EAST 87TH STREET SUITE 1A
NEW YORK NY
10128-0501
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-6900
  • Fax: 646-376-5140
Mailing address:
  • Phone: 212-996-6900
  • Fax: 646-376-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number219305
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: