Provider Demographics
NPI:1780759688
Name:MARC R SARNOW DPM
Entity type:Organization
Organization Name:MARC R SARNOW DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SARNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-563-0570
Mailing Address - Street 1:79 HAMMOND LN STE 9
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2008
Mailing Address - Country:US
Mailing Address - Phone:518-563-0570
Mailing Address - Fax:518-324-5406
Practice Address - Street 1:79 HAMMOND LN STE 9
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2008
Practice Address - Country:US
Practice Address - Phone:518-563-0570
Practice Address - Fax:518-324-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004680-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54274AMedicare PIN
W64321Medicare UPIN
VTVN1008Medicare PIN