Provider Demographics
NPI:1700113099
Name:BELSKY, MARVIN SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:SANFORD
Last Name:BELSKY
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 1:290 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8106
Mailing Address - Country:US
Mailing Address - Phone:212-787-5577
Mailing Address - Fax:212-787-2077
Practice Address - Street 1:290 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8106
Practice Address - Country:US
Practice Address - Phone:212-787-5577
Practice Address - Fax:212-787-2077
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY073312OtherDEA AB 1887073