Provider Demographics
NPI:1457427379
Name:WATSKY, MARVIN S (DO)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:S
Last Name:WATSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 EAST SUNRISE HWY
Mailing Address - Street 2:SUITE L19
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-957-3737
Mailing Address - Fax:631-957-8513
Practice Address - Street 1:150 EAST SUNRISE HWY
Practice Address - Street 2:SUITE L19
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-957-3737
Practice Address - Fax:631-957-8513
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1086411207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS1616OtherOXFORD
NY00241823Medicaid
0089890OtherGHI
NY724743Medicare ID - Type Unspecified
0089890OtherGHI