Provider Demographics
NPI:1225063274
Name:FLECKNER, MARK (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FLECKNER
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE L6
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5801
Mailing Address - Country:US
Mailing Address - Phone:516-739-5905
Mailing Address - Fax:516-739-6876
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:SUITE L6
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-739-5905
Practice Address - Fax:516-739-6876
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200481207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02059149Medicaid
NY02059149Medicaid
NYG14265Medicare UPIN