Provider Demographics
NPI:1588643654
Name:MARCO, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MARCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OLD CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1012
Mailing Address - Country:US
Mailing Address - Phone:201-391-3132
Mailing Address - Fax:201-659-1844
Practice Address - Street 1:720 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5078
Practice Address - Country:US
Practice Address - Phone:201-659-3379
Practice Address - Fax:201-659-1844
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0606481OtherAETNA HMO
NJ4279687OtherAETNA
NJP635006OtherOXFORD PROVIDER I.D.
NJ2083400Medicaid
NJ60006329OtherHORIZON HMO PROVIDER I.D.
NJ01007820100OtherAMERICHOICE
NJ2K8314OtherHEALTHNET
NJNJ01220OtherLANDMARK HEALTHCARE, INC. (HEALTH NET)
NJ60006329OtherHORIZON HMO PROVIDER I.D.