Provider Demographics
NPI:1154402774
Name:MARGOLIN, MARINA (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MARGOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GREENWAY
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-4604
Mailing Address - Country:US
Mailing Address - Phone:178-793-0874
Mailing Address - Fax:718-793-9267
Practice Address - Street 1:10917 72ND RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5336
Practice Address - Country:US
Practice Address - Phone:718-493-0874
Practice Address - Fax:718-793-4277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18756Medicare UPIN