Provider Demographics
NPI:1326056508
Name:GRESSER, MARK GEOFFREY (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GEOFFREY
Last Name:GRESSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:MT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766
Mailing Address - Country:US
Mailing Address - Phone:631-331-3338
Mailing Address - Fax:631-331-0014
Practice Address - Street 1:626 CANAL RD
Practice Address - Street 2:
Practice Address - City:MT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766
Practice Address - Country:US
Practice Address - Phone:631-331-3338
Practice Address - Fax:631-331-0014
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003743213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00886888Medicaid
NY00886888Medicaid
T51250Medicare UPIN