Provider Demographics
NPI:1922087766
Name:MARCUS, SERGIU L (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIU
Middle Name:L
Last Name:MARCUS
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 1:66 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1030
Mailing Address - Country:US
Mailing Address - Phone:212-772-2500
Mailing Address - Fax:212-772-6944
Practice Address - Street 1:140 E 80TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0306
Practice Address - Country:US
Practice Address - Phone:212-772-2500
Practice Address - Fax:212-772-6944
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150467207WX0107X, 207W00000X
NY150467-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00993375Medicaid
NYB87347Medicare UPIN