Glen Robert Mark, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

XOO7337-1 Issued in NY

Practice address

633 Roanoke Ave
Riverhead, NY 11901-2727

Phone

(631) 727-3795

Fax

(631) 727-1961

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Hallmark Chiropractic

  • Chiropractor
  • Riverhead, NY
  • NPI 1942248489
  Medicare reassignment NPD Authorized official
• Touch of Life Chiropractic East PC

  • Chiropractor
  • Eastport, NY
  • NPI 1285783795
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1669415238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012789",
            "telephone_number": "631-727-3795",
            "fax_number": "631-727-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012727",
            "telephone_number": "631-727-3795",
            "fax_number": "631-727-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "GLEN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "XOO7337-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "CO-7337-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pawan Marfatia, DO
• Eleanor Marin-Hurley
• Marina Homecare Agency of Ny, Inc.
• Kathleen Marino, L.C.S.W.
• Mark J Coronel MD PC
• Nancy Szendy Mark, D.C.
• Nicole Marie Marky, NP
• Martin Drugs of Riverhead,Inc
• Martin Drugs of Riverhead,Inc
• Mary Kathleen Martin, ANP

• Chiropractor in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.