Provider Demographics
NPI:1164596243
Name:SULTAN, MARLA BETH (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:BETH
Last Name:SULTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S BARRINGTON AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3346
Mailing Address - Country:US
Mailing Address - Phone:917-312-7330
Mailing Address - Fax:
Practice Address - Street 1:211 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1523
Practice Address - Country:US
Practice Address - Phone:516-746-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204963-1207W00000X
FLME-71586207W00000X
CAG87745207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61430Medicare UPIN
NY91T991Medicare ID - Type Unspecified