Healthcare Provider Details

I. General information

NPI: 1992038608
Provider Name (Legal Business Name): DAVID JOSHUA MARCUS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2009
Last Update Date: 09/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 BROADWAY
THORNWOOD NY
10594-1139
US

IV. Provider business mailing address

510 E 23RD ST APT #1F
NEW YORK NY
10010-5012
US

V. Phone/Fax

Practice location:
  • Phone: 914-769-0799
  • Fax: 914-769-5011
Mailing address:
  • Phone: 646-221-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: