Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 047036 | NY |
NPI | 1033125232 |
---|---|
Provider Name | Dr. Mark Marcus |
First Address | Saratoga Springs, NY 12866-1029 |
Second Address | Queensbury, NY 12804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |