Provider Demographics
NPI:1821167172
Name:KIRK, MARSHALL SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:SCOTT
Last Name:KIRK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1307
Mailing Address - Country:US
Mailing Address - Phone:347-247-3722
Mailing Address - Fax:
Practice Address - Street 1:63 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1307
Practice Address - Country:US
Practice Address - Phone:347-247-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO4696213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01187993Medicaid
NYP52461Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
NY01187993Medicaid