Provider Demographics
NPI:1508906744
Name:WILKENFELD, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WILKENFELD
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 1:453 FDR DR
Mailing Address - Street 2:SUITE 2002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5952
Mailing Address - Country:US
Mailing Address - Phone:212-614-9115
Mailing Address - Fax:
Practice Address - Street 1:453 FDR DR
Practice Address - Street 2:SUITE 2002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5952
Practice Address - Country:US
Practice Address - Phone:212-614-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167655-12083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2FF2T1Medicare PIN