Provider Demographics
NPI:1619064888
Name:ZOLAND, MARK P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:ZOLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 58TH ST STE 703
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1138
Mailing Address - Country:US
Mailing Address - Phone:212-628-8771
Mailing Address - Fax:212-794-0136
Practice Address - Street 1:133 E 58TH ST STE 703
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1138
Practice Address - Country:US
Practice Address - Phone:212-628-8771
Practice Address - Fax:212-794-0136
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG86590Medicare UPIN
NYIU3861Medicare ID - Type UnspecifiedMEDICARE ID