MEDICARE: DR. ANDREI MARK DDS

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	041022	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	041022	NY
3	1223X0008X	Oral and Maxillofacial Radiology Dentistry	041022	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112542	OTHER	NY	CIGNA HMO

General Provider Information

NPI Number	:	1992729628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREI MARK DDS

Provider Business Mailing Address
First Line	:	57 W 57TH ST
Second Line	:	SUITE#1004
City	:	NEW YORK
State	:	NY
Zip	:	10019-2802
Country	:	US
Telephone Number	:	212-813-0707
Fax Number	:	212-813-0808

Provider Business Practice Location Address
First Line	:	57 W 57TH ST
Second Line	:	SUITE#1004
City	:	NEW YORK
State	:	NY
Zip	:	10019-2802
Country	:	US
Telephone Number	:	212-813-0707
Fax Number	:	212-813-0808

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. ANDREI MARK DDS” Practice Location

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