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General NPI Number Information
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NPI Number | 1861563009
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Entity Type | Individual
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Provider Name | MARIN BUCEVIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 8570 148TH ST
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City | BRIARWOOD
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State | NY
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Zip | 11435-2832
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Country | US
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Telephone | 718-658-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 98 WILLOW ST
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City | GARDEN CITY
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State | NY
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Zip | 11530-6623
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Country | US
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Telephone | 516-742-4484
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 208941
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License Number State | NY
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