Provider Demographics
NPI:1215470604
Name:MARCUS, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 MORRIS AVE
Mailing Address - Street 2:P168X@203
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-6122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:339 MORRIS AVE
Practice Address - Street 2:P168X@203
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-6122
Practice Address - Country:US
Practice Address - Phone:718-585-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist