Provider Demographics
NPI:1598043432
Name:MARMUR DERMATOLOGY AND CARDIOLOGY, PLLC
Entity Type:Organization
Organization Name:MARMUR DERMATOLOGY AND CARDIOLOGY, PLLC
Other - Org Name:MARMUR MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARMUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-996-6900
Mailing Address - Street 1:12 E 87TH ST SUITE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0501
Mailing Address - Country:US
Mailing Address - Phone:212-996-6900
Mailing Address - Fax:646-376-5140
Practice Address - Street 1:12 E 87TH ST SUITE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0501
Practice Address - Country:US
Practice Address - Phone:212-996-6900
Practice Address - Fax:646-376-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219305207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100053466Medicare PIN