Provider Demographics
NPI:1750485991
Name:ROSS, MARC K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:K
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2497
Mailing Address - Fax:212-563-0605
Practice Address - Street 1:227 E 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2602
Practice Address - Country:US
Practice Address - Phone:212-995-6661
Practice Address - Fax:212-979-3579
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2024-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1842452081P0301X
NY1842451208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01449229Medicaid
NY01449229Medicaid
NY75H531Medicare ID - Type UnspecifiedEMPIRE MEDICARE