Healthcare Provider Details

I. General information

NPI: 1467643965
Provider Name (Legal Business Name): LARA V MARCUSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 34TH ST 4TH FL
NEW YORK NY
10016-4972
US

IV. Provider business mailing address

18 E 41ST ST SUITE 1206
NEW YORK NY
10017-6222
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8871
  • Fax:
Mailing address:
  • Phone: 212-725-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number238985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: