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General NPI Number Information
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NPI Number | 1487888673
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Entity Type | Individual
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Provider Name | MARC WILLIAM MANSEAU M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 356 W 18TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-4401
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Country | US
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Telephone | 347-687-4704
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Fax |
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Provider Business Mailing Address
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Address Line | 237 DEVOE ST APT 3R
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City | BROOKLYN
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State | NY
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Zip | 11211-3806
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Country | US
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Telephone | 401-524-1545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 258596
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 258596
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License Number State | NY
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