Provider Demographics
NPI:1255956116
Name:SIDMAN, MARSHALL (BENEFITS COORDINATOR)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:
Last Name:SIDMAN
Suffix:
Gender:M
Credentials:BENEFITS COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7920
Mailing Address - Country:US
Mailing Address - Phone:718-779-1600
Mailing Address - Fax:347-612-4162
Practice Address - Street 1:9114 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7920
Practice Address - Country:US
Practice Address - Phone:718-779-1600
Practice Address - Fax:347-612-4162
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-1715175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist