MEDICARE: MARVIN MORDKOFF MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	115542	NY

General Provider Information

NPI Number	:	1073546123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIN MORDKOFF MD PC

Provider Business Mailing Address
First Line	:	1175 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1211
Country	:	US
Telephone Number	:	212-722-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1211
Country	:	US
Telephone Number	:	212-722-3400
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CARDIOLOGIST
Name	:	DR. MARIVIN MORDKOFF
Credential	:	MD PC
Telephone Number	:	212-722-3400

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/30/2008

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