Provider Demographics
NPI:1588613871
Name:NASH, MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:NASH
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 1:52 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1814
Mailing Address - Country:US
Mailing Address - Phone:914-666-2220
Mailing Address - Fax:914-666-2987
Practice Address - Street 1:52 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1814
Practice Address - Country:US
Practice Address - Phone:914-666-2220
Practice Address - Fax:914-666-2987
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1018502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00389657Medicaid
NY0560BAMedicare ID - Type UnspecifiedGHI
NY00389657Medicaid
B80202Medicare UPIN