Mark Abdurakhmanov

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Stony Brook, NY

NPI 1265370076 · NPPES record last updated Mar 23, 2026

Key facts

NPI
1265370076
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
101 County Rd 97
Stony Brook, NY 11794-0001
Phone
(631) 689-8333
NPI assigned
Mar 23, 2026
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

101 County Rd 97
Stony Brook, NY 11794-0001

Mailing address

101 County Rd 97
Stony Brook, NY 11794-0001

Other providers in Stony Brook, NY

All providers in Stony Brook, NY · Student in an Organized Health Care Education/Training Program in New York

Sources for this page

Verify at the official NPI Registry.