Basic Information
| Provider Information | |||||||||
| NPI: | 1720585672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARDER | ||||||||
| FirstName: | SHIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63 SANFORD LN | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069052819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144200349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146826511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2018 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 30683601 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.