Provider Demographics
NPI:1053303073
Name:IMUNDO, MARC R (MD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:R
Last Name:IMUNDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:230 HILTON AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8115
Mailing Address - Country:US
Mailing Address - Phone:516-742-4442
Mailing Address - Fax:516-505-0768
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:STE 107
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-742-4442
Practice Address - Fax:516-505-0768
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY124361207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B20584Medicare UPIN
969371Medicare ID - Type Unspecified