Provider Demographics
NPI:1407928393
Name:NEWMARK, ALAN JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:NEWMARK
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 1:34 PLAZA ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:718-857-9004
Mailing Address - Fax:718-857-7251
Practice Address - Street 1:34 PLAZA ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-857-9004
Practice Address - Fax:718-857-7251
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003108213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00602355Medicaid
NY00602355Medicaid
NYP33642Medicare PIN
NY5444490001Medicare NSC
NYP33641Medicare PIN