Healthcare Provider Details

I. General information

NPI: 1780855684
Provider Name (Legal Business Name): MARK ROBERT SCHUFMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VARICK ST 9TH FLOOR
NEW YORK NY
10014-4810
US

IV. Provider business mailing address

17625 UNION TPKE #432
FRESH MEADOWS NY
11366-1515
US

V. Phone/Fax

Practice location:
  • Phone: 212-620-0340
  • Fax:
Mailing address:
  • Phone: 917-885-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number032421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: