Provider Demographics
NPI:1124050109
Name:SISLOWITZ, MARCEL J
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:J
Last Name:SISLOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1715
Mailing Address - Country:US
Mailing Address - Phone:212-362-4200
Mailing Address - Fax:212-721-1392
Practice Address - Street 1:585 W END AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1715
Practice Address - Country:US
Practice Address - Phone:212-362-4200
Practice Address - Fax:212-721-1392
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094924207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY952121Medicare PIN
NYB20345Medicare UPIN