MEDICARE: MARKE BANCHIK, 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	207L00000X	Anesthesiology Physician	151864	NY

General Provider Information

NPI Number	:	1467659532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARKE BANCHIK, MD PC

Provider Business Mailing Address
First Line	:	PO BOX 2125
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11022-2125
Country	:	US
Telephone Number	:	516-829-1853
Fax Number	:	516-829-1853

Provider Business Practice Location Address
First Line	:	11 GATEWAY DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1924
Country	:	US
Telephone Number	:	516-829-1853
Fax Number	:	516-829-1853

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK EDWARD BANCHIK
Credential	:	MD
Telephone Number	:	516-829-1853

Provider Enumeration Date	:	06/30/2007
Last Update Date	:	08/22/2020

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