Provider Demographics
NPI:1568549319
Name:STEIN, MARK NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:NATHAN
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-5874
Mailing Address - Fax:212-305-6762
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-5874
Practice Address - Fax:212-305-6762
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215813207RH0000X, 207RX0202X
NJ25MA07779100207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046574Medicaid
NJ085244AHEMedicare PIN
NJ085244Medicare ID - Type Unspecified
NJI20875Medicare UPIN