Provider Demographics
NPI:1407040496
Name:MARSH DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:MARSH DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-344-1350
Mailing Address - Street 1:1600 HARRISON AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3145
Mailing Address - Country:US
Mailing Address - Phone:914-698-2190
Mailing Address - Fax:914-698-0308
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3145
Practice Address - Country:US
Practice Address - Phone:914-698-2190
Practice Address - Fax:914-698-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196411-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZZRR1Medicare PIN