Provider Demographics
NPI:1467947150
Name:MCGILL, MARCUS MARIO (NP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:MARIO
Last Name:MCGILL
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:954 LEXINGTON AVE # 2095
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5055
Mailing Address - Country:US
Mailing Address - Phone:646-561-9673
Mailing Address - Fax:646-661-4499
Practice Address - Street 1:1781 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5341
Practice Address - Country:US
Practice Address - Phone:646-561-9673
Practice Address - Fax:646-661-4499
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF402406-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF402406-1OtherSTATE OF NEW YORK EDUCATION DEPARTMENT