Provider Demographics
NPI:1326148990
Name:MELTZER, MARC JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JAY
Last Name:MELTZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:70 GLEN COVE RD
Mailing Address - Street 2:SUITE # 306
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1726
Mailing Address - Country:US
Mailing Address - Phone:516-621-7720
Mailing Address - Fax:516-625-4521
Practice Address - Street 1:70 GLEN COVE RD
Practice Address - Street 2:SUITE # 306
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1726
Practice Address - Country:US
Practice Address - Phone:516-621-7720
Practice Address - Fax:516-625-4521
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY164722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64690Medicare UPIN
NY89D961Medicare ID - Type Unspecified