Healthcare Provider Details

I. General information

NPI: 1629654363
Provider Name (Legal Business Name): MARK JOSEPH MAGUIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HEALTHY WAY
OCEANSIDE NY
11572
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE BOX 1264
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number342899
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number342899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: