Provider Demographics
NPI:1558769844
Name:ENDELSON, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ENDELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CONGRESS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3338
Mailing Address - Country:US
Mailing Address - Phone:561-734-3550
Mailing Address - Fax:
Practice Address - Street 1:1000 N CONGRESS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3338
Practice Address - Country:US
Practice Address - Phone:561-734-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6364156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician