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General NPI Number Information
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NPI Number | 1164848818
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Entity Type | Organization
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Legal Business Name | DOCTORS MEDICAL OFFICE PLLC
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1825 MERRICK RD
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City | MERRICK
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State | NY
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Zip | 11566-4559
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Country | US
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Telephone | 516-867-5132
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Fax | 516-867-5519
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Provider Business Mailing Address
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Address Line | 1825 MERRICK RD
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City | MERRICK
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State | NY
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Zip | 11566-4559
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Country | US
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Telephone | 516-867-5132
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Fax | 516-867-5519
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | DR. MARK HALTRECHT
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Credential | DO
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Telephone | 516-867-5132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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