MEDICARE: DR. MARK GVENTER DPM, P.C.

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	213ES0131X	Foot Surgery Podiatrist	N002605	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	A400024901	OTHER	NY	MEDICARE PTAN

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
2	2210604	OTHER	NY	AETNA
3	P618996	OTHER	NY	OXFORD
4	0085809	OTHER	NY	GHI
5	1343406-005	OTHER	NY	CIGNA
6	4C7517	OTHER	NY	HEALTHNET
7	63679	OTHER	NY	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1821093840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GVENTER DPM, P.C.

Provider Business Mailing Address
First Line	:	2965 OCEAN PKWY
Second Line	:	STE 403
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8014
Country	:	US
Telephone Number	:	718-265-1140
Fax Number	:	718-648-2211

Provider Business Practice Location Address
First Line	:	2965 OCEAN PKWY
Second Line	:	STE 403
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8014
Country	:	US
Telephone Number	:	718-265-1140
Fax Number	:	718-648-2211

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/13/2010

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Directions to “ DR. MARK GVENTER DPM, P.C.” Practice Location

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