Provider Demographics
NPI:1356457758
Name:MICHAEL Z. MARDER DDS AND ROBERT W. MARDER DMD, RC.
Entity Type:Organization
Organization Name:MICHAEL Z. MARDER DDS AND ROBERT W. MARDER DMD, RC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MARDOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-265-8291
Mailing Address - Street 1:119 WEST 57TH ST.
Mailing Address - Street 2:SUITE 1507
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-265-8291
Mailing Address - Fax:212-265-8291
Practice Address - Street 1:119 WEST 57TH ST.
Practice Address - Street 2:SUITE 1507
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-265-8291
Practice Address - Fax:212-265-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty