Provider Demographics
NPI:1619398823
Name:MARK DRAKOS MD PLLC
Entity Type:Organization
Organization Name:MARK DRAKOS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-606-1112
Mailing Address - Street 1:333 EARLE OVINGTON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3645
Mailing Address - Country:US
Mailing Address - Phone:212-606-1112
Mailing Address - Fax:516-794-0215
Practice Address - Street 1:523 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4099
Practice Address - Country:US
Practice Address - Phone:212-606-1112
Practice Address - Fax:516-794-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233502207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7038950001OtherMEDICARE DME