Provider Demographics
NPI:1619034600
Name:MARZUK, PETER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:MARZUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 YORK AVE
Mailing Address - Street 2:ROOM C-203 BOX 243
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4805
Mailing Address - Country:US
Mailing Address - Phone:212-746-1203
Mailing Address - Fax:212-746-8935
Practice Address - Street 1:1300 YORK AVE
Practice Address - Street 2:ROOM C-203 BOX 243
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4805
Practice Address - Country:US
Practice Address - Phone:212-746-1203
Practice Address - Fax:212-746-8935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1581382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry