Provider Demographics
NPI:1487685913
Name:MOSTEL, MARCY (MD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:MOSTEL
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 1:5 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5720
Mailing Address - Country:US
Mailing Address - Phone:631-351-6115
Mailing Address - Fax:631-351-6115
Practice Address - Street 1:5 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5720
Practice Address - Country:US
Practice Address - Phone:631-351-6115
Practice Address - Fax:631-351-6115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1595932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01382663Medicaid
NY70119Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NY70119TMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY01382663Medicaid