Provider Demographics
NPI:1538740071
Name:MARSHALL, DAVID ANTHONY
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:MARSHALL
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 1:880 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3301
Mailing Address - Country:US
Mailing Address - Phone:718-613-7529
Mailing Address - Fax:718-613-7564
Practice Address - Street 1:880 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3301
Practice Address - Country:US
Practice Address - Phone:718-613-7529
Practice Address - Fax:718-613-7564
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
NY7203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No282N00000XHospitalsGeneral Acute Care Hospital