Provider Demographics
NPI:1114949450
Name:STERLING, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:STERLING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:48 ROUTE 25A
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1431
Mailing Address - Country:US
Mailing Address - Phone:631-863-1007
Mailing Address - Fax:631-862-3668
Practice Address - Street 1:48 ROUTE 25A
Practice Address - Street 2:SUITE 106
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1431
Practice Address - Country:US
Practice Address - Phone:631-863-1007
Practice Address - Fax:631-862-3668
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1917573-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71Z721OtherEMPIRE BC/BS
NY250012559Medicare PIN
NY20Z0985961Medicare PIN
NYG45389Medicare UPIN