Provider Demographics
NPI:1477563716
Name:MARVIN S WATSKY PC
Entity Type:Organization
Organization Name:MARVIN S WATSKY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WATSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-957-3737
Mailing Address - Street 1:150 E SUNRISE HWY
Mailing Address - Street 2:SUITE L19
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-957-3737
Mailing Address - Fax:
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:SUITE L19
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-957-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1086411207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0089890OtherGHI
NY00241823Medicaid
NY724743OtherEMPIRE BCBS
AS1616OtherOXFORD
B19074Medicare UPIN
NYWEU791Medicare ID - Type Unspecified