MEDICARE: MICHAEL Z. MARDER DDS AND ROBERT W. MARDER DMD, RC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	24104	NY

General Provider Information

NPI Number	:	1356457758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL Z. MARDER DDS AND ROBERT W. MARDER DMD, RC.

Provider Business Mailing Address
First Line	:	119 WEST 57TH ST.
Second Line	:	SUITE 1507
City	:	NEW YORK
State	:	NY
Zip	:	10019
Country	:	US
Telephone Number	:	212-265-8291
Fax Number	:	212-265-8291

Provider Business Practice Location Address
First Line	:	119 WEST 57TH ST.
Second Line	:	SUITE 1507
City	:	NEW YORK
State	:	NY
Zip	:	10019
Country	:	US
Telephone Number	:	212-265-8291
Fax Number	:	212-265-8291

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL Z MARDOR
Credential	:	D.D.S.
Telephone Number	:	212-265-8291

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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