MEDICARE: MARK R LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225547060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK R LLC

Provider Business Mailing Address
First Line	:	3762 85TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7347
Country	:	US
Telephone Number	:	718-600-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3762 85TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7347
Country	:	US
Telephone Number	:	718-600-2454
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MARCIO REYES
Credential	:
Telephone Number	:	718-600-2454

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	01/09/2024

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Directions to “MARK R LLC ” Practice Location

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