Provider Demographics
NPI:1437337953
Name:MARK SCHILANSKY
Entity Type:Organization
Organization Name:MARK SCHILANSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-822-1124
Mailing Address - Street 1:67 PROSPECT AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2917
Mailing Address - Country:US
Mailing Address - Phone:518-822-1124
Mailing Address - Fax:
Practice Address - Street 1:35 FIVE MILE WOODS RD
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5913
Practice Address - Country:US
Practice Address - Phone:518-943-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003122-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0359830002Medicare NSC