Provider Demographics
NPI:1962661785
Name:MARC R IMUNDO MD PC
Entity Type:Organization
Organization Name:MARC R IMUNDO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:IMUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-742-4442
Mailing Address - Street 1:230 HILTON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8115
Mailing Address - Country:US
Mailing Address - Phone:516-742-4442
Mailing Address - Fax:516-505-0768
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-742-4442
Practice Address - Fax:516-505-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYRTZ1Medicare PIN
NY969371Medicare PIN
NY41Z881Medicare PIN