Healthcare Provider Details

I. General information

NPI: 1811974140
Provider Name (Legal Business Name): MARC R SARNOW DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HAMMOND LN STE 9
PLATTSBURGH NY
12901-2008
US

IV. Provider business mailing address

79 HAMMOND LN STE 9
PLATTSBURGH NY
12901-2008
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-0570
  • Fax: 518-324-5406
Mailing address:
  • Phone: 518-563-0570
  • Fax: 518-324-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0560000158
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0046801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: