Provider Demographics
NPI:1578620225
Name:GRUSENSKY, MARC HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:HARRIS
Last Name:GRUSENSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2171 JERICHO TURNPIKE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-499-4224
Mailing Address - Fax:631-499-1535
Practice Address - Street 1:2171 JERICHO TURNPIKE
Practice Address - Street 2:SUITE 210
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-499-4224
Practice Address - Fax:631-499-1535
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1191352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1191352OtherWCB
NY25A641Medicare ID - Type Unspecified