Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 033221 | NY |
NPI | 1033260690 |
---|---|
Provider Name | Dr. Mark S Hochberg |
First Address | Glen Head, NY 11545-2795 |
Second Address | New York, NY 10021-3242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |