Ethan Andrew Mack, MD, PHD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

334916 Issued in NY

Practice address

622 W 168TH St PH 1564W
New York, NY 10032-3720

Phone

(212) 305-7399

NPI assigned

Apr 10, 2020

Last updated

Jun 4, 2026By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in PA, NY2 enrollments

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 2

Specialty

Pathology

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trustees of Columbia University in the City of New YorkGroup PAC ID 8527972546, 2,262 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• New York-Presbyterian Hospital Hospital, New York, NY, CCN 330101

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Trustees of Columbia University in the City of New York

  • Surgery Physician
  • New York, NY
  • NPI 1508266347
  Medicare reassignment Care Compare group NPD
• University of Penn-Medical Group

  • Gynecologic Oncology Physician
  • Philadelphia, PA
  • NPI 1235527342
  Medicare reassignment NPD
• Trustees of Columbia University in the City of New York

  • Internal Medicine Physician
  • New York, NY
  • NPI 1699289488

  Anatomic Pathology & Clinical Pathology

  NPD
• Trustees of Columbia University in the City of New York

  • Internal Medicine Physician
  • New York, NY
  • NPI 1861907321
  NPD
• University of Penn-Medical Group

  • Ambulatory Fertility Facility
  • Philadelphia, PA
  • NPI 1669860854
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Columbia Presbyterian Pathologists

  • Anatomic Pathology & Clinical Pathology Physician
  • New York, NY
  • NPI 1679507594
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The New York and Presbyterian Hospital

  dba New York Presbyterian Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1144504044
  Care Compare affiliation
• The New York and Presbyterian Hospital

  dba New York-Presbyterian Hospital

  • Ambulance
  • New York, NY
  • NPI 1174628473

  Hospital

  Care Compare affiliation
• The New York and Presbyterian Hospital

  dba NewYork-Presbyterian Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1194832477
  Care Compare affiliation
• The New York and Presbyterian Hospital

  • General Acute Care Hospital
  • Bronxville, NY
  • NPI 1780196345
  Care Compare affiliation
• The New York and Presbyterian Hospital

  dba New York-Presbyterian Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1952332801
  Care Compare affiliation

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

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1922627843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST PH 1564W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "ETHAN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-10",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "334916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mack Dermatology, P.C. (GlamDerm)
• Charles Mack, MD
• Denise Marie Mack, R.N.
• Dianne Mack
• Erin Mack
• Jason Mack, MD
• Jennifer T Mack
• Jeremy R Mack, MD
• Keisha Mack, FNP-C
• Lian Alana Mack, MD

• Anatomic Pathology & Clinical Pathology Physician in New York, NY
• Providers in New York, NY by specialty
• Anatomic Pathology & Clinical Pathology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.