NPIMap

Organization Active NPI

Mark Medical Care, PLLC

  • Specialist
  • Deer Park, NY
National Provider Identifier
1962745398
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2147731 Issued in NY
Legal business name
MARK MEDICAL CARE, PLLC
Practice address
2103 Deer Park Ave Ste 200
Deer Park, NY 11729-1317
Phone
(631) 574-2060
NPI assigned
Apr 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Authorized official

Name
Ron Mark, MDNPI 1013917301
Title
President
Phone
(576) 376-5562

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 2147731 NY Primary

Addresses

Primary practice location

2103 Deer Park Ave Ste 200
Deer Park, NY 11729-1317

Mailing address

6 Annette Way
Jericho, NY 11753-2836
Phone (516) 376-5562

Other practice location 1

6405 Woodside Ave
Woodside, NY 11377-3654
Phone (877) 376-2751

Other practice location 2

385 W Sunrise Hwy
Freeport, NY 11520-3120
Phone (516) 321-4747

Other practice location 3

5503 Myrtle Ave
Ridgewood, NY 11385-3550
Phone (631) 574-2060

Other identifiers 1

IdentifierTypeStateIssuer
04427969MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131202001150 NY Part B Supplier - Clinic/Group Practice 9234365982 Receives reassigned benefits from 8 practitioners
Practice locations: Freeport, NY; Westbury, NY; Riverhead, NY; Ridgewood, NY; New York, NY; Medford, NY; Jackson Heights, NY; Glen Cove, NY…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2187570Mark Medical Care PLLC385 West Sunrise Hwy, Freeport, NY 11520Certificate of waiverJul 2, 2028
33D2187572Mark Medical Care PLLC2103 Deer Park Avenue 2ND FL, Deer Park, NY 11729Certificate of waiverJul 2, 2028

National Provider Directory

National Provider Directory

Locations

354 E 149th St
Bronx, NY 10455

2103 Deer Park Ave
Ste 2
Deer Park, NY 11729

195 Forest Ave
Unit B
Glen Cove, NY 11542

7814 Roosevelt Ave
Ste 1
Jackson Heights, NY 11372

2775 Route 112
Ste B
Medford, NY 11763

1370 Saint Nicholas Ave
Frnt 1
New York, NY 10033

1105 Old Country Rd
Unit 1111
Riverhead, NY 11901

1111 Route 58
Riverhead, NY 11901

1105 Old Country Rd
Unit 1111RT58
Riverhead, NY 11901

1137 Old Country Rd
Ste C
Westbury, NY 11590

1137 Old Country Rd
Unit C
Westbury, NY 11590

1083 Old Country Rd
Westbury, NY 11590

6405 Woodside Ave
Ste 1
Woodside, NY 11377
Phone (877) 376-2751

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1962745398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 ANNETTE WAY",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532836",
            "telephone_number": "516-376-5562",
            "fax_number": "949-863-8548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE STE 200",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291317",
            "telephone_number": "631-574-2060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6405 Woodside Ave",
            "address_purpose": "LOCATION",
            "city": "Woodside",
            "state": "NY",
            "postal_code": "113773654",
            "country_code": "US",
            "telephone_number": "877-376-2751",
            "fax_number": "877-673-8535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "385 W Sunrise Hwy",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "NY",
            "postal_code": "115203120",
            "country_code": "US",
            "telephone_number": "516-321-4747",
            "fax_number": "877-673-8535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5503 Myrtle Ave",
            "address_purpose": "LOCATION",
            "city": "Ridgewood",
            "state": "NY",
            "postal_code": "113853550",
            "country_code": "US",
            "telephone_number": "631-574-2060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARK MEDICAL CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-04",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "MARK",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "576-376-5562",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "2147731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04427969",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.