Provider Demographics
NPI:1962578229
Name:MARC, JEFFREY C (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:MARC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:MARC
Other - Last Name:CHWATUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 SHEEPSHEAD BAY RD LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3651
Mailing Address - Country:US
Mailing Address - Phone:718-332-7717
Mailing Address - Fax:718-615-9590
Practice Address - Street 1:1711 SHEEPSHEAD BAY RD
Practice Address - Street 2:LOVER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3651
Practice Address - Country:US
Practice Address - Phone:718-332-7717
Practice Address - Fax:718-615-9590
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00855789Medicaid
NY00855789Medicaid
C08057Medicare UPIN