Healthcare Provider Details

I. General information

NPI: 1780661769
Provider Name (Legal Business Name): MARK CWERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 55TH ST
NYC NY
10022
US

IV. Provider business mailing address

305 E 55TH ST
NYC NY
10022
US

V. Phone/Fax

Practice location:
  • Phone: 212-751-9714
  • Fax: 212-832-1821
Mailing address:
  • Phone: 212-751-9714
  • Fax: 212-832-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number125031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: