Provider Demographics
NPI:1295703205
Name:ADLER, MARC S (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:ADLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-0208
Mailing Address - Country:US
Mailing Address - Phone:516-538-0300
Mailing Address - Fax:516-745-1519
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-538-0300
Practice Address - Fax:516-745-1519
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01837067Medicaid
NYG25870Medicare UPIN
NY01837067Medicaid
NY004AE1Medicare ID - Type UnspecifiedPERSONAL ID NUMBER MEDICA