Individual
IRA E MARDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1033 GREEN ACRES MALL, VALLEY STREAM, NY 11581-1531
(516) 825-8990
(516) 872-2702
Mailing address
155 LAKESIDE DR, OAKDALE, NY 11769-2150
(631) 567-2504
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
3751
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01016646
—
NY
Enumeration date
10/27/2006
Last updated
07/08/2007
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