Healthcare Provider Details

I. General information

NPI: 1811976921
Provider Name (Legal Business Name): MARK PERSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE EAST BIMC- DEPT OF OTOLARYNGOLOGY
NEW YORK NY
10003
US

IV. Provider business mailing address

PO BOX 32887
HARTFORD CT
06150
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8706
  • Fax:
Mailing address:
  • Phone: 212-256-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1165981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: