Provider Demographics
NPI:1588983761
Name:MARCUS, JUSTIN ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROSS
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CENTRAL PARK W APT 8B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7629
Mailing Address - Country:US
Mailing Address - Phone:305-904-2891
Mailing Address - Fax:
Practice Address - Street 1:520 E 70TH ST # 607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:212-746-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2784272084N0400X, 208M00000X
NY278427-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400118208OtherMEDICARE PTAN
NY04067305Medicaid
NYA400122561OtherMEDICARE PTAN