Provider Demographics
NPI:1053305094
Name:MARK FLUGMAN, M.D., P.C.
Entity Type:Organization
Organization Name:MARK FLUGMAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-766-6400
Mailing Address - Street 1:176 N VILLAGE AVE
Mailing Address - Street 2:SUITE # 2A
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3800
Mailing Address - Country:US
Mailing Address - Phone:516-766-6400
Mailing Address - Fax:516-766-6457
Practice Address - Street 1:176 N VILLAGE AVE
Practice Address - Street 2:SUITE # 2A
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-766-6400
Practice Address - Fax:516-766-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141643207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26950POtherHIP'S PROVIDER #
NY00831829Medicaid
NY08D891OtherBC/BS'S PROVIDER #
NY6531OtherVYTRA'S PROVIDER #
NYAB45800OtherMDNY'S PROVIDER #
NYAS677OtherOXFORD'S PROVIDER #
NY0092460OtherGHI PROVIDER #
NY0098128OtherAETNA US HEALTHCARE #
NY00831829Medicaid