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General NPI Number Information
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NPI Number | 1962745398
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Entity Type | Organization
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Legal Business Name | MARK MEDICAL CARE, PLLC
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 2103 DEER PARK AVE STE 200
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City | DEER PARK
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State | NY
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Zip | 11729-1317
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Country | US
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Telephone | 631-574-2060
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Fax |
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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 | 516-376-5562
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Fax | 949-863-8548
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Authorized Official
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Title or Position | PRESIDENT
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Name | RON MARK
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Credential | MD
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Telephone | 576-376-5562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2147731
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License Number State | NY
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