Provider Demographics
NPI:1093702730
Name:AMIR, MARK EHUD (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EHUD
Last Name:AMIR
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:3311 SHORE PKWY
Mailing Address - Street 2:APT FF
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3937
Mailing Address - Country:US
Mailing Address - Phone:718-648-0888
Mailing Address - Fax:718-921-9349
Practice Address - Street 1:1514 VOORHIES AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-648-0888
Practice Address - Fax:718-648-0411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2019-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013940-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAM3940OtherATLANTIS HEALTH PLAN
NY175543OtherELDERPLAN
NY20587POtherHIP
NY02203285Medicaid
NYP2522968OtherOXFORD
NY2C6646OtherHEALTH NET
NY6699902OtherGHI
NYS70550Medicare UPIN
NYQ01571Medicare ID - Type Unspecified
NYMAQ01571Medicare ID - Type Unspecified