Healthcare Provider Details

I. General information

NPI: 1821394354
Provider Name (Legal Business Name): MARK ANDREW MISENER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LAFAYETTE ST 19TH FLOOR
NEW YORK NY
10007-1307
US

IV. Provider business mailing address

2 LAFAYETTE ST 19TH FLOOR
NEW YORK NY
10007-1307
US

V. Phone/Fax

Practice location:
  • Phone: 212-676-2285
  • Fax:
Mailing address:
  • Phone: 212-676-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number205903
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: