Provider Demographics
NPI:1982421871
Name:ENGRAM, MARCUS (RN)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:ENGRAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 EDGEWATER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4929
Mailing Address - Country:US
Mailing Address - Phone:315-507-1805
Mailing Address - Fax:
Practice Address - Street 1:685 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN NY
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-221-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY877887163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent