Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MAC6232 | NJ |
NPI | 1013075951 |
---|---|
Provider Name | John W Marcus |
First Address | Ridgewood, NJ 07450 |
Second Address | Ridgewood, NJ 07450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F53406 | (02) |