Provider Demographics
NPI:1346244878
Name:FORMAN, MARCUS STEVEN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:STEVEN
Last Name:FORMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 WEST 57 STREET
Mailing Address - Street 2:6TH FL.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-799-6700
Mailing Address - Fax:212-799-4533
Practice Address - Street 1:152 WEST 57 STREET
Practice Address - Street 2:6TH FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-799-6700
Practice Address - Fax:212-799-4533
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0174861225100000X
174861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist