Provider Demographics
NPI:1164752317
Name:MARC SAFRAN, MD PLLC
Entity Type:Organization
Organization Name:MARC SAFRAN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAFRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-622-1234
Mailing Address - Street 1:8340 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1026
Mailing Address - Country:US
Mailing Address - Phone:315-622-1234
Mailing Address - Fax:315-622-0018
Practice Address - Street 1:8340 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1026
Practice Address - Country:US
Practice Address - Phone:315-622-1234
Practice Address - Fax:315-622-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty