Provider Demographics
NPI:1437116191
Name:SIROTA, MARC ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:SIROTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 13TH ST
Mailing Address - Street 2:APT. 8B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5329
Mailing Address - Country:US
Mailing Address - Phone:718-728-3400
Mailing Address - Fax:718-721-7562
Practice Address - Street 1:3127 41ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3901
Practice Address - Country:US
Practice Address - Phone:718-728-3400
Practice Address - Fax:718-721-7562
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146643207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY57239HMedicare ID - Type Unspecified
NYA96588Medicare UPIN