Provider Demographics
NPI:1275510026
Name:PISIK, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:PISIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:4631 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3301
Practice Address - Country:US
Practice Address - Phone:315-487-4844
Practice Address - Fax:315-484-1213
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-05-02
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Provider Licenses
StateLicense IDTaxonomies
NY188634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080067466Medicare PIN
NYF50001Medicare UPIN
NY55290PMedicare PIN