Provider Demographics
NPI:1952302325
Name:FOUCHER, MARC
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:FOUCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2117
Mailing Address - Country:US
Mailing Address - Phone:631-981-5287
Mailing Address - Fax:631-981-5288
Practice Address - Street 1:2701 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2117
Practice Address - Country:US
Practice Address - Phone:631-981-5287
Practice Address - Fax:631-981-5288
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005144213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU49487Medicare UPIN