Provider Demographics
NPI:1891563961
Name:MARMOR NY DENTAL PC
Entity Type:Organization
Organization Name:MARMOR NY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARMOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-835-6004
Mailing Address - Street 1:76 PROGRESS DR STE 123
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3603
Mailing Address - Country:US
Mailing Address - Phone:914-835-6004
Mailing Address - Fax:914-560-2216
Practice Address - Street 1:306 GRANT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1404
Practice Address - Country:US
Practice Address - Phone:914-835-6004
Practice Address - Fax:914-560-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty