Healthcare Provider Details

I. General information

NPI: 1114339710
Provider Name (Legal Business Name): MARNE OSHAE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N CAYUGA ST
ITHACA NY
14850-4291
US

IV. Provider business mailing address

402 N CAYUGA ST
ITHACA NY
14850-4291
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-5551
  • Fax: 607-275-0313
Mailing address:
  • Phone: 607-273-5551
  • Fax: 607-275-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number228335-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARNE OSHAE
Title or Position: OWNER
Credential: M.D.
Phone: 607-273-5551