Physician Compare National (NPI:1356682652)

HEALTHCARE PROVIDER: MARK-MINA MAHER ISHAK D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1356682652
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3870822513
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190905003057
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ISHAK
	Individual professional last name
Provider First Name	MARK MINA
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2019
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2500 NESCONSET HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	BLDG 18C
	Group Practice or individual's line 2 address
City	STONY BROOK
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	117902563
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330401
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST CATHERINE OF SIENA HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330141
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330185
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M