Provider Demographics
NPI:1740388602
Name:SAFRAN, MARC J (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:SAFRAN
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 1:8340 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1026
Mailing Address - Country:US
Mailing Address - Phone:315-622-1234
Mailing Address - Fax:315-622-0018
Practice Address - Street 1:8340 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1026
Practice Address - Country:US
Practice Address - Phone:315-622-1234
Practice Address - Fax:315-622-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200315207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000004734OtherBLUE CROSS BLUE SHIELD
NY01575795Medicaid
NY175120OtherMVP
2121252OtherAETNA
2121252OtherAETNA
2121252OtherAETNA