MEDICARE: MARC CANTILLON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA07805000	NJ
2	2084P0800X	Psychiatry Physician	190659	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	567BS	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1427037803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC CANTILLON M.D.

Provider Business Mailing Address
First Line	:	134 WALNUT ST
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2513
Country	:	US
Telephone Number	:	973-462-0496
Fax Number	:	973-486-8344

Provider Business Practice Location Address
First Line	:	134 WALNUT ST
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2513
Country	:	US
Telephone Number	:	973-462-0496
Fax Number	:	973-486-8344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	06/19/2008

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