Provider Demographics
NPI:1134114192
Name:MARCUS, MICHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
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 1:977 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:948 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2918
Practice Address - Country:US
Practice Address - Phone:718-283-8260
Practice Address - Fax:718-635-7235
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1489032080P0201X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113491197OtherMULTIPLAN
NY113491197OtherPHCS
NY3C2614OtherHEALTH NET
NY299910401OtherHEALTH PLUS
NY4293337OtherAETNA PPO
NY82N0131OtherNEIGHBORHOOD HEALTH
NYBKX0148-13OtherAMERICHOICE
NYMM8903OtherATLANTIS HEALTH PLAN
NYP2037616OtherOXFORD HEALTH PLANS
NY202460OtherUNITED HEALTH CARE
NY0907635Medicaid
NY148903-A15OtherHEALTH FIRST
NY92Q181OtherEMPIRE BCBS
NY82N0131OtherNEIGHBORHOOD HEALTH
NY0907635Medicaid