=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598926412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON THE MARK INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2008
-----------------------------------------------------
Last Update Date | 04/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 258 N STATE ROAD 7
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-4557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-876-8037
-----------------------------------------------------
Fax | 954-973-1668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 258 N STATE ROAD 7
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-4557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-876-8037
-----------------------------------------------------
Fax | 954-973-1668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK NATHAN DOBIN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 954-876-8037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | OPC 1202
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------