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General NPI Number Information
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NPI Number | 1174083828
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Entity Type | Organization
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Legal Business Name | MARK MEDICAL CARE QUEENS PLLC
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 6405 WOODSIDE AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-3654
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Country | US
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Telephone | 877-376-2751
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Fax | 877-673-8535
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Provider Business Mailing Address
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Address Line | 6 ANNETTE WAY
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City | JERICHO
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State | NY
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Zip | 11753-2836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. RON MARK
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Credential | MD
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Telephone | 631-574-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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