MEDICARE: MRS. SANDRA G MARCUS MA

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	235Z00000X	Speech-Language Pathologist	013843-1	NY

General Provider Information

NPI Number	:	1740421320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA G MARCUS MA

Provider Business Mailing Address
First Line	:	1657 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2547
Country	:	US
Telephone Number	:	917-667-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1657 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2547
Country	:	US
Telephone Number	:	917-667-0511
Fax Number	:

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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