Provider Demographics
NPI:1336122654
Name:BITTON, MARK AVI (M D)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:AVI
Last Name:BITTON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:AVI
Other - Last Name:BITTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10025 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2454
Mailing Address - Country:US
Mailing Address - Phone:718-997-1400
Mailing Address - Fax:718-997-7921
Practice Address - Street 1:10025 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2454
Practice Address - Country:US
Practice Address - Phone:718-997-1400
Practice Address - Fax:718-997-7921
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153828207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00761688Medicaid
NY56087Medicare ID - Type Unspecified
NY56087CMedicare PIN
NYE42395Medicare UPIN