Healthcare Provider Details

I. General information

NPI: 1093633224
Provider Name (Legal Business Name): MARK MARTIN OVESNY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HAWLEY LN
STRATFORD CT
06614-1202
US

IV. Provider business mailing address

55 RUSSIAN VILLAGE RD
SOUTHBURY CT
06488-2110
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-5988
  • Fax:
Mailing address:
  • Phone: 304-476-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number007866
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: