Provider Demographics
NPI:1700158623
Name:MARC S ENGELBERT MD PLLC
Entity Type:Organization
Organization Name:MARC S ENGELBERT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENGELBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-348-4100
Mailing Address - Street 1:1165 PARK AVENUE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1210
Mailing Address - Country:US
Mailing Address - Phone:212-348-4100
Mailing Address - Fax:212-987-7543
Practice Address - Street 1:1165 PARK AVENUE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1210
Practice Address - Country:US
Practice Address - Phone:212-348-4100
Practice Address - Fax:212-987-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154792207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69D421Medicare PIN