Provider Demographics
NPI:1508892274
Name:PESSAH, MARIUS LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIUS
Middle Name:LEON
Last Name:PESSAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-437-1616
Mailing Address - Fax:516-354-6048
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-437-1616
Practice Address - Fax:516-354-6048
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY114082207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY41791OtherVYTRA
NY46599OtherMDNY
NY11A39OtherEMPIRE BLUE SHIELD
NY112458161Other1199 NATIONAL BENEFIT FUN
NY5504617001OtherCIGNA
NYAS807OtherOXFORD
NY2C8020OtherHEALTHNET
NY1532050OtherUNITED HEALTHCARE
NY41791OtherVYTRA
NY5504617001OtherCIGNA