Healthcare Provider Details

I. General information

NPI: 1114101169
Provider Name (Legal Business Name): MARK FENIG M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

201 MANOR PL
GREENPORT NY
11944-1222
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2000
  • Fax:
Mailing address:
  • Phone: 631-477-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number267120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: