Provider Demographics
NPI:1851668156
Name:STANDA, MARCIN
Entity Type:Individual
Prefix:MR
First Name:MARCIN
Middle Name:
Last Name:STANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARCIN
Other - Middle Name:
Other - Last Name:STANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7 OAKLEAF DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6234
Mailing Address - Country:US
Mailing Address - Phone:518-588-9092
Mailing Address - Fax:
Practice Address - Street 1:7 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-588-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021042-12251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics