Healthcare Provider Details

I. General information

NPI: 1215972641
Provider Name (Legal Business Name): MARCUS HOTALING PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 UNION ST
NISKAYUNA NY
12309-6901
US

IV. Provider business mailing address

1 OLD COUNTRY RD SUITE 271
CARLE PLACE NY
11514-1801
US

V. Phone/Fax

Practice location:
  • Phone: 518-346-6935
  • Fax: 518-381-3945
Mailing address:
  • Phone: 800-725-6280
  • Fax: 800-725-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015350-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: