Provider Demographics
NPI:1295080117
Name:WINKLER, MARSHALL (MS,ED)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:
Last Name:WINKLER
Suffix:
Gender:M
Credentials:MS,ED
Other - Prefix:MR
Other - First Name:MARSHALL
Other - Middle Name:
Other - Last Name:WINKLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,ED
Mailing Address - Street 1:29 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 CEDAR PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1401
Practice Address - Country:US
Practice Address - Phone:917-604-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor