Provider Demographics
NPI:1407843352
Name:PRIMACK, MARSHALL PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:PHILIP
Last Name:PRIMACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 25TH ST 2KK
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3172
Mailing Address - Country:US
Mailing Address - Phone:212-683-3588
Mailing Address - Fax:
Practice Address - Street 1:101 CENTRAL PARK W
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4250
Practice Address - Country:US
Practice Address - Phone:212-769-2570
Practice Address - Fax:212-769-2931
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099626207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY099626-C26OtherFIRST HEALTH
NY3774907OtherCIGNA HEALTH PLANS
NY137516OtherWELLCARE
NY4294225OtherAETNA HEALTH PLANS
NY1000000367OtherAFFINITY
NY0C1100OtherHEALTHNET
NY959081OtherBLUE CROSS
NY8778423210OtherUNITED HEALTHCARE
NY00493605Medicaid
NYNP373OtherOXFORD HEALTH PLANS
NY137516OtherWELLCARE