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General NPI Number Information
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NPI Number | 1881910305
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Entity Type | Organization
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Legal Business Name | ST. MARKS MEDICAL, P.C.
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 907 SAINT MARKS AVE
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City | BROOKLYN
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State | NY
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Zip | 11213-2004
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Country | US
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Telephone | 718-756-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 907 SAINT MARKS AVE
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City | BROOKLYN
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State | NY
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Zip | 11213-2004
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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 | MD
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Name | ANDREW D BLACK
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Credential |
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Telephone | 718-756-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 143801
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License Number State | NY
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