Healthcare Provider Details

I. General information

NPI: 1326056508
Provider Name (Legal Business Name): MARK GEOFFREY GRESSER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 CANAL RD
MT SINAI NY
11766
US

IV. Provider business mailing address

626 CANAL RD
MT SINAI NY
11766
US

V. Phone/Fax

Practice location:
  • Phone: 631-331-3338
  • Fax: 631-331-0014
Mailing address:
  • Phone: 631-331-3338
  • Fax: 631-331-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003743
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: