Provider Demographics
NPI:1750471553
Name:ANDREW T MARSHALL MD PC
Entity Type:Organization
Organization Name:ANDREW T MARSHALL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-593-4200
Mailing Address - Street 1:16 FARMSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2602
Mailing Address - Country:US
Mailing Address - Phone:516-625-8985
Mailing Address - Fax:
Practice Address - Street 1:1800 ROCKAWAY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1665
Practice Address - Country:US
Practice Address - Phone:516-593-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193405207QA0505X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6251150001Medicare NSC
NYWAA031Medicare PIN
21N641Medicare ID - Type Unspecified
6251150001Medicare PIN