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General NPI Number Information
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NPI Number | 1437120912
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Entity Type | Organization
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Legal Business Name | MIRMARC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 770 MCLEAN AVE
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City | YONKERS
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State | NY
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Zip | 10704-3843
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Country | US
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Telephone | 914-803-0500
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Fax | 914-803-0600
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Provider Business Mailing Address
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Address Line | 770 MCLEAN AVE
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City | YONKERS
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State | NY
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Zip | 10704-3843
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Country | US
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Telephone | 914-803-0500
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Fax | 914-803-0600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC WAYNE GREENBERG
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Credential | O.D.
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Telephone | 914-803-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT004416
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License Number State | NY
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