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General NPI Number Information
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NPI Number | 1417928896
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Entity Type | Individual
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Provider Name | MARK SIVAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 5 EAST 98 ST, 7TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10029-6501
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Country | US
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Telephone | 212-241-7076
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Fax | 212-860-4952
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Provider Business Mailing Address
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Address Line | 5 EAST 98 ST, BOX 1139
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City | NEW YORK
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State | NY
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Zip | 10029-6501
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Country | US
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Telephone | 212-241-7076
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Fax | 212-860-4952
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 114630
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License Number State | NY
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