Healthcare Provider Details

I. General information

NPI: 1043551831
Provider Name (Legal Business Name): DAVID MARSHAK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W 115TH ST 350
NEW YORK NY
10025-7722
US

IV. Provider business mailing address

145 DREISER LOOP
BRONX NY
10475-2704
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MARSHAK
Title or Position: OWNER
Credential: MD
Phone: 908-653-9399