Individual provider Active NPI

Mark S Trachtman, MD

  • Ophthalmology Physician
  • Allentown, PA
National Provider Identifier
1417902198
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD046669L Issued in PA
Practice address
400 N 17TH St
Ste 101
Allentown, PA 18104
Phone
(610) 433-0450
Fax
(610) 433-4655
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD046669L PA Primary

Addresses

Primary practice location

400 N 17TH St
Ste 101
Allentown, PA 18104

Mailing address

825 E Gate Blvd Ste 111
Garden City, NY 11530-2136
Phone (516) 804-5200

Other identifiers 1

IdentifierTypeStateIssuer
1302211MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110405000132 PA Practitioner - Ophthalmology 0840213922 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD046669LPAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Eye Center, P.C. CurrentSince Jun 8, 1992 Accepting new patients

Locations

825 E Gate Blvd
Ste 111
Garden City, NY 11530
Phone (516) 804-5200

400 N 17th St
Ste 104
Allentown, PA 18104
Phone (610) 433-0450

400 N 17th St
Ste 101
Allentown, PA 18104
Phone (215) 433-0450

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1417902198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 E GATE BLVD STE 111",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115302136",
            "telephone_number": "516-804-5200",
            "fax_number": "631-309-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N 17TH ST",
            "address_2": "STE 101",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "18104",
            "telephone_number": "610-433-0450",
            "fax_number": "610-433-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACHTMAN",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD046669L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1302211",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.