Healthcare Provider Details

I. General information

NPI: 1053315614
Provider Name (Legal Business Name): MARCUS H LOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CANAL STREET SUITE 3001
NEW YORK NY
10013-3501
US

IV. Provider business mailing address

254 CANAL ST SUITE 3001
NEW YORK NY
10013-3501
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8388
  • Fax: 212-941-7426
Mailing address:
  • Phone: 212-925-8388
  • Fax: 212-941-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number159685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: