Provider Demographics
NPI:1083926372
Name:MARK E. PRUZANSKY, MD, PC
Entity Type:Organization
Organization Name:MARK E. PRUZANSKY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRUZANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-249-8700
Mailing Address - Street 1:975 PARK AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0323
Mailing Address - Country:US
Mailing Address - Phone:212-249-8700
Mailing Address - Fax:212-327-4405
Practice Address - Street 1:975 PARK AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0323
Practice Address - Country:US
Practice Address - Phone:212-249-8700
Practice Address - Fax:212-327-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100028737OtherMEDICARE PTAN
NYB07757Medicare UPIN