Healthcare Provider Details

I. General information

NPI: 1750471553
Provider Name (Legal Business Name): ANDREW T MARSHALL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ROCKAWAY AVE SUITE 201
HEWLETT NY
11557-1665
US

IV. Provider business mailing address

16 FARMSTEAD LN
GLEN HEAD NY
11545-2602
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-4200
  • Fax:
Mailing address:
  • Phone: 516-625-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number193405
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANDREW TODD MARSHALL
Title or Position: PRESIDENT
Credential: MD
Phone: 516-593-4200