Provider Demographics
NPI:1740433325
Name:MARCUS H LOO MD LLC
Entity Type:Organization
Organization Name:MARCUS H LOO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-925-8388
Mailing Address - Street 1:254 CANAL ST
Mailing Address - Street 2:SUITE 3001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3501
Mailing Address - Country:US
Mailing Address - Phone:212-925-8388
Mailing Address - Fax:212-941-7426
Practice Address - Street 1:254 CANAL ST
Practice Address - Street 2:SUITE 3001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3501
Practice Address - Country:US
Practice Address - Phone:212-925-8388
Practice Address - Fax:212-941-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707271Medicaid
NY3S4012Medicare UPIN