Provider Demographics
NPI:1669538609
Name:MARCUS, ALLAN I (OD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:I
Last Name:MARCUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 BLANKETFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2437
Mailing Address - Country:US
Mailing Address - Phone:609-371-0805
Mailing Address - Fax:
Practice Address - Street 1:50 MALL DR W
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1601
Practice Address - Country:US
Practice Address - Phone:201-222-2423
Practice Address - Fax:201-420-1750
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00352100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA521600Medicare ID - Type Unspecified
NJU26922Medicare UPIN