Mark Antosh MD PC

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

1061151 Issued in NY

Legal business name

MARK ANTOSH MD PC

Practice address

824 Franklin Park Dr
East Syracuse, NY 13057-1614

Phone

(315) 432-1048

Fax

(315) 432-9219

NPI assigned

Sep 29, 2006

Last updated

Nov 13, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Antosh, MDNPI 1295746584

Title

President

Phone

(315) 432-9202

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Yoffa and Antosh MD's PC Former legal business name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Antosh, M.D.

  • Legal Medicine
  • East Syracuse, NY
  • NPI 1295746584
  Medicare reassignment NPD Authorized official
• Lynn Hickox, NP;CNM

  • Midwife
  • E Syracuse, NY
  • NPI 1609871003
  Medicare reassignment NPD
• Dale S Clemens

  • Optician
  • East Syracuse, NY
  • NPI 1659438455
  NPD (past)
• David M Girardi, O.D.

  • Optometrist
  • Syracuse, NY
  • NPI 1558452516
  NPD (past)
• Vanna A Reisman, CNM

  • Obstetrics & Gynecology Nurse Practitioner
  • East Syracuse, NY
  • NPI 1801878640
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447372800000",
    "number": "1184716888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 FRANKLIN PARK DR",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571614",
            "telephone_number": "315-432-9202",
            "fax_number": "315-432-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 FRANKLIN PARK DR",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571614",
            "telephone_number": "315-432-1048",
            "fax_number": "315-432-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK ANTOSH MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2015-11-13",
        "status": "A",
        "authorized_official_last_name": "ANTOSH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-432-9202",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "1061151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01420837",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00572349",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yoffa and Antosh MD's PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mancera Dental LLC
• Praveen Kumar Mandera Govindaiah, D.M.D
• Paul Manfredo
• Katelyn Mannara, DPT, PT
• Carole Anne Marascalchi, M.S., CCC-SLP
• Leonard Marotta, MD
• Caryn Suzanne Marr, OTR/L
• Marie Christina Martini, LMT
• Mary L Oot, FNP, P.C.
• Mary Lou Corcoran PT, P.C.

• Legal Medicine in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Legal Medicine in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.