Provider Demographics
NPI:1730161894
Name:SILVERMAN, MARC M (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:M
Last Name:SILVERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3413
Mailing Address - Country:US
Mailing Address - Phone:631-421-0958
Mailing Address - Fax:631-421-0959
Practice Address - Street 1:27 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3413
Practice Address - Country:US
Practice Address - Phone:631-421-0958
Practice Address - Fax:631-421-0959
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00411312Medicaid
NYC26951Medicare ID - Type Unspecified
NYP00366812Medicare PIN
NY00411312Medicaid