Provider Demographics
NPI:1205831435
Name:ISDITH, MARJORIE J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:J
Last Name:ISDITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HICKSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-795-5700
Mailing Address - Fax:516-795-5701
Practice Address - Street 1:20 HICKSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-795-5700
Practice Address - Fax:516-795-5701
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY650491OtherBLUE CROSS
NY617701OtherAETNA
NYDA48287OtherMDNY
NYP403153OtherOXFORD
NY1392024OtherUNITED HEALTH
NY65911OtherVYTRA
NY6012892OtherGHI
NY617701OtherAETNA
NY65911OtherVYTRA