MEDICARE: MARK S BRISKIN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	034344	NY

General Provider Information

NPI Number	:	1164544367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK S BRISKIN DDS PC

Provider Business Mailing Address
First Line	:	547 SAW MILL RIVER RD
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-2143
Country	:	US
Telephone Number	:	914-693-1221
Fax Number	:	914-693-0868

Provider Business Practice Location Address
First Line	:	547 SAW MILL RIVER RD
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-2143
Country	:	US
Telephone Number	:	914-693-1221
Fax Number	:	914-693-0868

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK S. BRISKIN
Credential	:	DDS
Telephone Number	:	914-693-1221

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/22/2020

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