Healthcare Provider Details

I. General information

NPI: 1679597744
Provider Name (Legal Business Name): NORMAN MARCUS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 40TH ST STE 1100
NEW YORK NY
10016-1201
US

IV. Provider business mailing address

30 E 40TH ST STE 1100
NEW YORK NY
10016-1201
US

V. Phone/Fax

Practice location:
  • Phone: 212-532-7999
  • Fax: 212-532-5957
Mailing address:
  • Phone: 212-532-7999
  • Fax: 212-532-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number102747
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: