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General NPI Number Information
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NPI Number | 1255982542
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Entity Type | Organization
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Legal Business Name | MARCUS AVENUE MEDICAL PC
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 232 E 30TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-8202
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Country | US
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Telephone | 212-447-1609
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Fax | 212-679-4275
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Provider Business Mailing Address
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Address Line | 232 E 30TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-8202
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Country | US
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Telephone | 212-447-1609
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Fax | 212-679-4275
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT & CFO
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Name | MRS. MICHELE L CUSACK
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Credential |
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Telephone | 516-321-6058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RT0003X
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Taxonomy Name | Transplant Hepatology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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