Provider Demographics
NPI:1427001411
Name:MARK L. MEYER, MD, PLLC
Entity Type:Organization
Organization Name:MARK L. MEYER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-583-2999
Mailing Address - Street 1:110 E 59TH ST
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-583-2999
Mailing Address - Fax:212-407-3909
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:SUITE 9B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-583-2999
Practice Address - Fax:212-407-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220772207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
928601OtherMEDICARE ID #
G45673Medicare UPIN