Healthcare Provider Details

I. General information

NPI: 1922333640
Provider Name (Legal Business Name): MARLA S EGLOWSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 09/16/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 NEW SCOTLAND AVE
ALBANY NY
12208-3555
US

IV. Provider business mailing address

6423 ZORN RD
ALBANY NY
12203-5942
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5013
  • Fax:
Mailing address:
  • Phone: 518-423-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number168249
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number168249
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number168249
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number168249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: