Provider Demographics
NPI:1427362557
Name:TEMKIN, MARILYN LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:LISA
Last Name:TEMKIN
Suffix:
Gender:F
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:PO BOX 2037
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0704
Mailing Address - Country:US
Mailing Address - Phone:631-689-1518
Mailing Address - Fax:
Practice Address - Street 1:225 RABRO DRIVE EAST
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4290
Practice Address - Country:US
Practice Address - Phone:631-790-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144976207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB10914Medicare UPIN