Provider Demographics
NPI:1255344099
Name:MARCUS, JONATHAN A (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 278984
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14627-8984
Mailing Address - Country:US
Mailing Address - Phone:585-275-0275
Mailing Address - Fax:585-273-1255
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG C-215
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2627
Practice Address - Country:US
Practice Address - Phone:585-341-7420
Practice Address - Fax:585-273-1255
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2562182084N0400X
NY256218-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400029596OtherMEDICARE PTAN