Healthcare Provider Details

I. General information

NPI: 1033614045
Provider Name (Legal Business Name): MARK HELLERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-3816
US

IV. Provider business mailing address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-3278
  • Fax:
Mailing address:
  • Phone: 212-305-5996
  • Fax: 212-305-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number314341
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number314341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: