Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 041022 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 041022 | NY |
N | 1223X0008X | Oral and Maxillofacial Radiology | 041022 | NY |
NPI | 1992729628 |
---|---|
Provider Name | Dr. Andrei Mark |
First Address | New York, NY 10019-2802 |
Second Address | New York, NY 10019-2802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112542 | CIGNA HMO (01) | NY |