Provider Demographics
NPI:1306938659
Name:MARGOLIES, MICHAEL BRUCE (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:MARGOLIES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1002
Mailing Address - Country:US
Mailing Address - Phone:718-623-2030
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY
Practice Address - Street 2:EAST BUILDING, 6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4201
Practice Address - Country:US
Practice Address - Phone:212-227-3350
Practice Address - Fax:212-227-3379
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist