MARC IMMERMAN (NPI# 1417967712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417967712 |
| Entity Type | Individual |
| Full Name | MARC IMMERMAN |
| Credential | M.D. |
| Practice Address |
1003 Walnut St Elmira NY 14901-1007 |
| Practice Telephone | 6077325646 |
| Practice Fax Number | 6077320373 |
| Mailing Telephone | 6077325646 |
| Mailing Fax Number | 6077320373 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2018-02-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 174214 | NY | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 174214 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | BCBS | 000915192004 | 01 |
| NY | 01144467 | 05 |
| Street Address |
1003 WALNUT ST |
| City | ELMIRA |
| State | NY |
| Zip Code | 14901-1007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154898658 | Olivia Spadafora | Social Worker | 1003 Walnut St, Elmira, NY 14901-1007 | 2018-11-01 |
| 1700979572 | Sophia Bezirganian | Psychiatry & Neurology | 1003 Walnut St, Elmira, NY 14901-1007 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447818182 | Davida Reane Moss | Case Manager/Care Coordinator | 310 Pensyvania Avenue, Elmira, NY 14901 | 2019-05-29 |
| 1316504889 | Jessica Leigh Badilla | Counselor | 1013 Water St, Elmira, NY 14901 | 2019-05-21 |
| 1427508811 | Cynthia Ann Sullivan | Counselor | 1019 E. Water Street, Elmira, NY 14901 | 2016-10-10 |
| 1508313362 | Kim Burlew | Case Manager/Care Coordinator | 1019 W. Water Street Family Services of Chemung County, Elmire, NY 14901 | 2016-09-08 |
| 1396195095 | State of New York Comptrollers Office | Clinic/Center | 164 Sullivan Street, Elmira, NY 14901 | 2016-06-14 |
| 1285089581 | Tasha R Miller | Licensed Practical Nurse | 426 Woodawn Ct, Elmira, NY 14901 | 2016-04-25 |
| 1750628111 | Kelly E Bartle-bush | Social Worker | 711 Sullivan St., Elmira, NY 14901 | 2013-01-04 |
| 1144594946 | Brian Mustico | Occupational Therapist | 512 West Clinton Street, Apartment B, Elmira, NY 14901 | 2012-02-27 |
| 1063780880 | Deidre Ann Callaghan | Physical Therapy Assistant | 555 St.josephs Blvd, Elmira, NY 14901 | 2011-12-07 |
| 1972889467 | Arnot Health | General Acute Care Hospital | 1 St.joseph's Blvd., Elmira, NY 14901 | 2011-10-27 |
| Find all providers in zip 14901 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194139469 | Ryan Kenny | General Practice | 602 Ivy St, Elmira, NY 14905-1646 | 2014-06-16 |
| 1992146807 | Munson Healthcare Otsego Memorial Hospital | General Practice | 2572 N Us Highway 131, Elmira, MI 49730 | 2013-07-09 |
| 1265871339 | Munson Healthcare Otsego Memorial Hospital | General Practice | 2572 N Us Highway 131, Elmira, MI 49730 | 2013-06-21 |
| 1073782066 | Daniel Albert Fisher Jr. | General Practice | 650 Baldwin St, Elmira, NY 14901-2216 | 2008-02-25 |
| 1154489714 | West Elmira Optical | General Practice | 227 Hoffman St, Elmira, NY 14905 | 2006-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420472 | Theodean Smith-lawrence | General Practice | 7 Smoke Rise Ln, Wappingers Falls, NY 12590-1220 | 2020-09-03 |
| 1891304325 | Christopher R. Page, M.d., Pllc | General Practice | 46 Route 25a Ste 6, Setauket, NY 11733-2807 | 2020-07-30 |
| 1740804442 | Aliza Hakimian | General Practice | 15 Hill Park Ave Apt 2n, Great Neck, NY 11021-3709 | 2020-05-29 |
| 1962022152 | Lynnette Lallave - Cortes | General Practice | 2 Seaman Ave Apt 1d, New York, NY 10034-2904 | 2020-04-17 |
| 1942829759 | Northeasttelemedicine | General Practice | 483 Coolidge Hill Rd, Diamond Point, NY 12824 | 2020-04-11 |
| 1578198826 | Online Care Medicine PC | General Practice | 26 Oldox Rd, Delmar, NY 12054-2943 | 2020-03-06 |
| 1821621301 | Donnet Andrea Riley | General Practice | 781 Palmer Rd Apt 3a, Bronxville, NY 10708-3309 | 2020-02-12 |
| 1104463652 | Ohad Shimshon Bentur | General Practice | 450 E 63rd St Apt 3g, New York, NY 10065-7957 | 2019-12-03 |
| 1285278291 | Echo Clinical Associates LLC | General Practice | 56 Echo Ave., Ste 1, Miller Place, NY 11764-2454 | 2019-11-01 |
| 1710528583 | Debra Heverly | General Practice | 2315 Whirlpool St # 415, Niagara Falls, NY 14305-2413 | 2019-10-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.