Provider Demographics
NPI:1902332018
Name:MARC EVERETT MD P.C.
Entity type:Organization
Organization Name:MARC EVERETT MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-774-7715
Mailing Address - Street 1:936 5TH AVE # 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2653
Mailing Address - Country:US
Mailing Address - Phone:212-774-7715
Mailing Address - Fax:516-900-5022
Practice Address - Street 1:936 5TH AVE # 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2653
Practice Address - Country:US
Practice Address - Phone:212-774-7715
Practice Address - Fax:516-900-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287559208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty