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General NPI Number Information
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NPI Number | 1720253487
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Entity Type | Organization
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Legal Business Name | MARJORIE J ISDITH DO PC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 20 HICKSVILLE RD SUITE 5
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5819
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Country | US
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Telephone | 516-795-5700
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Fax | 516-795-5701
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Provider Business Mailing Address
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Address Line | 20 HICKSVILLE RD SUITE 5
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5819
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Country | US
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Telephone | 516-795-5700
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Fax | 516-795-5701
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARJORIE J ISDITH
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Credential | D.O.
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Telephone | 516-795-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 197492
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License Number State | NY
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