Mark S Petersen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

036653 Issued in NY

Practice address

7 Elm St
Coxsackie, NY 12051-1301

Phone

(518) 731-2797

NPI assigned

Feb 5, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marvin a. Gertzberg, D.D.S.

  • Dentist
  • West Coxsackie, NY
  • NPI 1477714236
  NPD (past)
• New Baltimore Family Dentistry, LLP

  • General Practice Dentistry
  • West Coxsackie, NY
  • NPI 1174944243
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255470365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 CHAPEL RD",
            "city": "GILBOA",
            "state": "NY",
            "postal_code": "120762613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ELM ST",
            "city": "COXSACKIE",
            "state": "NY",
            "postal_code": "120511301",
            "telephone_number": "518-731-2797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MARK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "036653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jon Stephen Miller, M.D.
• Barbara Ann Moor, RN
• Diane M Oringer, LPN
• Katelyn Palermo, PA-C
• Maura Pearlstein
• Mary Ann Proper, RN CWOCN
• D Ann Rugh, PT
• Thomas Anthony Russo, PA
• Doreen Smith, MD
• State of New York Office of State Comptroller (Coxsackie Pharmacy)

• General Practice Dentistry in Coxsackie, NY
• Providers in Coxsackie, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.