Provider Demographics
NPI:1679565295
Name:RICHARD W. MARCUS, M.D.
Entity type:Organization
Organization Name:RICHARD W. MARCUS, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-667-6676
Mailing Address - Street 1:242 WASHINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3934
Mailing Address - Country:US
Mailing Address - Phone:973-667-6676
Mailing Address - Fax:973-667-6029
Practice Address - Street 1:242 WASHINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3934
Practice Address - Country:US
Practice Address - Phone:973-667-6676
Practice Address - Fax:973-667-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7933401Medicaid