Provider Demographics
NPI:1700875846
Name:AGULNICK, MARC ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ADAM
Last Name:AGULNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-0303
Mailing Address - Country:US
Mailing Address - Phone:516-739-9270
Mailing Address - Fax:516-248-1727
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 470
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-739-9270
Practice Address - Fax:516-248-1727
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230967-1207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0267363Medicaid
NYI32497Medicare UPIN
NY645G11Medicare ID - Type Unspecified