Provider Demographics
NPI:1720140767
Name:LONDON, MARC DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:LONDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 CROSFIELD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2219
Mailing Address - Country:US
Mailing Address - Phone:845-353-4344
Mailing Address - Fax:845-348-1873
Practice Address - Street 1:2 CROSFIELD AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2219
Practice Address - Country:US
Practice Address - Phone:845-353-4344
Practice Address - Fax:845-348-1873
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1546022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00956818-03Medicaid
NY3850735-002OtherCIGNA
NY66D101OtherBLUE CHOICE
NYRS156OtherOXFORD
NY000000008354OtherGHI HMO
NY1000017387OtherAFFINITY
NY122304OtherUS HEALTHCARE
NY4199225OtherAETNA
NY958837OtherMVP
NY066D10Medicare ID - Type Unspecified
NY00956818-03Medicaid