MEDICARE: DR. MARK SHLOMOVICH M.D.

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	208000000X	Pediatrics Physician	267571	NY
2	2080P0203X	Pediatric Critical Care Medicine Physician	267571	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790065910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SHLOMOVICH M.D.

Provider Business Mailing Address
First Line	:	826 MEEHAN AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-5509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 WAYNE AVE FL 8
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2552
Country	:	US
Telephone Number	:	718-741-2037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	10/16/2017

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