Provider Demographics
NPI:1003833575
Name:GARELICK, MARVIN SIDNEY (DO)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:SIDNEY
Last Name:GARELICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GARDINERS AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756
Mailing Address - Country:US
Mailing Address - Phone:516-796-3666
Mailing Address - Fax:516-735-5446
Practice Address - Street 1:550 GARDINERS AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756
Practice Address - Country:US
Practice Address - Phone:516-796-3666
Practice Address - Fax:516-735-5446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMG266811Medicare ID - Type Unspecified
B11905Medicare UPIN