Healthcare Provider Details

I. General information

NPI: 1093606972
Provider Name (Legal Business Name): DR. MARK ABDELMESIH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 3RD AVE STE 406
BRONX NY
10451-6340
US

IV. Provider business mailing address

98 JEWETT AVE
JERSEY CITY NJ
07304-2602
US

V. Phone/Fax

Practice location:
  • Phone: 347-913-4656
  • Fax:
Mailing address:
  • Phone: 201-238-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: