Provider Demographics
NPI:1114101169
Name:FENIG, MARK (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FENIG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MANOR PL
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1222
Mailing Address - Country:US
Mailing Address - Phone:631-477-1000
Mailing Address - Fax:
Practice Address - Street 1:201 MANOR PL
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1222
Practice Address - Country:US
Practice Address - Phone:631-477-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267120207P00000X
GA002633207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine