Provider Demographics
NPI:1043498769
Name:MARK GVENTER DPM, PC
Entity Type:Organization
Organization Name:MARK GVENTER DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GVENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-265-1140
Mailing Address - Street 1:286 CORBIN PL
Mailing Address - Street 2:APT# 6E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4948
Mailing Address - Country:US
Mailing Address - Phone:718-265-1140
Mailing Address - Fax:718-648-2211
Practice Address - Street 1:2965 OCEAN PKWY
Practice Address - Street 2:SUITE # 403
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8014
Practice Address - Country:US
Practice Address - Phone:718-265-1140
Practice Address - Fax:718-648-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002605213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000006367901OtherAMERICHOICE
NYP618996OtherOXFORD
NY00415018Medicaid
NY63679OtherUNITED HEALTHCARE
NY0085809OtherGHI
NY2210604OtherAETNA
NY336060101OtherHEALTHPLUS
NYA100024900Medicare PIN
NY336060101OtherHEALTHPLUS