Provider Demographics
NPI:1073583928
Name:ZOMBEK, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ZOMBEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MEIR
Other - Middle Name:
Other - Last Name:ZOMBEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0000
Mailing Address - Country:US
Mailing Address - Phone:631-225-7200
Mailing Address - Fax:631-225-4565
Practice Address - Street 1:150 E SUNRISE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-225-7200
Practice Address - Fax:631-225-4565
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1497942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00931604Medicaid
NYB17099Medicare UPIN
NY00931604Medicaid