Provider Demographics
NPI:1700067899
Name:WINNEGRAD, MARC DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:DAVID
Last Name:WINNEGRAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LINFORD CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2706
Mailing Address - Country:US
Mailing Address - Phone:732-625-9387
Mailing Address - Fax:
Practice Address - Street 1:380 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6208
Practice Address - Country:US
Practice Address - Phone:212-579-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02901908Medicaid