Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 091906 | NY |
NPI | 1003833575 |
---|---|
Provider Name | Marvin Sidney Garelick |
First Address | Levittown, NY 11756 |
Second Address | Levittown, NY 11756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B11905 | (02) |