MEDICARE: MARK FROMER, MD 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1194851774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK FROMER, MD PC

Provider Business Mailing Address
First Line	:	3130 GRAND CONCOURSE
Second Line	:	SUITE 1J
City	:	BRONX
State	:	NY
Zip	:	10458-1213
Country	:	US
Telephone Number	:	718-741-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE
Second Line	:	SUITE 1J
City	:	BRONX
State	:	NY
Zip	:	10458-1213
Country	:	US
Telephone Number	:	718-741-3200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT-CEO
Name	:	DR. MARK FROMER
Credential	:	MD
Telephone Number	:	212-832-9228

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	03/18/2008

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