Provider Demographics
NPI:1003836172
Name:DELUTY, MARVIN ZEV (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ZEV
Last Name:DELUTY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16604 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3234
Mailing Address - Country:US
Mailing Address - Phone:718-380-8434
Mailing Address - Fax:
Practice Address - Street 1:16604 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3234
Practice Address - Country:US
Practice Address - Phone:718-380-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008155103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY28415Medicare ID - Type UnspecifiedQUEENS COUNTY
NYVS1861Medicare ID - Type UnspecifiedNEW YORK