Provider Demographics
NPI:1750414108
Name:AGIN, MARILYN C (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:C
Last Name:AGIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:107 W 90TH ST
Mailing Address - Street 2:TH-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1254
Mailing Address - Country:US
Mailing Address - Phone:212-274-9180
Mailing Address - Fax:212-219-3688
Practice Address - Street 1:107 W 90TH ST
Practice Address - Street 2:TH-H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1254
Practice Address - Country:US
Practice Address - Phone:212-274-9180
Practice Address - Fax:212-219-3688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1719562080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAG589058Medicare ID - Type Unspecified