Healthcare Provider Details

I. General information

NPI: 1922056472
Provider Name (Legal Business Name): MARK W DOBRINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CUTTER MILL RD 507
GREAT NECK NY
11021
US

IV. Provider business mailing address

20 LUCILLE LN
DIX HILLS NY
11746-5810
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-8738
  • Fax: 516-487-1601
Mailing address:
  • Phone: 631-425-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number175980
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number175980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: