Provider Demographics
NPI:1275983900
Name:TYE, MARCUS
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:TYE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MARCUS
Other - Middle Name:CHOI
Other - Last Name:TYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:310 LENOX RD APT 7N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2230
Mailing Address - Country:US
Mailing Address - Phone:646-397-3215
Mailing Address - Fax:
Practice Address - Street 1:310 LENOX RD APT 7N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2230
Practice Address - Country:US
Practice Address - Phone:646-397-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist