Healthcare Provider Details

I. General information

NPI: 1023047487
Provider Name (Legal Business Name): GARY T MARSHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE NBV 15 S 14
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

550 1ST AVE NBV 15 S 14
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6509
  • Fax:
Mailing address:
  • Phone: 212-263-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number267752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: