Provider Demographics
NPI:1598738957
Name:MANN, MARILYN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2213
Mailing Address - Country:US
Mailing Address - Phone:845-634-3240
Mailing Address - Fax:
Practice Address - Street 1:612 CORPORATE WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2021
Practice Address - Country:US
Practice Address - Phone:845-268-0045
Practice Address - Fax:845-268-0998
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004435-1152W00000X
NJ270A00445400152W00000X
FLOPC1998152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P674678OtherOXFORD
P674678OtherOXFORD
NYT81539Medicare UPIN