Provider Demographics
NPI:1639445869
Name:MARK J CORONEL MD PC
Entity Type:Organization
Organization Name:MARK J CORONEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORONEL
Authorized Official - Suffix:
Authorized Official - Credentials:PC OWNER
Authorized Official - Phone:631-591-3000
Mailing Address - Street 1:34 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3118
Mailing Address - Country:US
Mailing Address - Phone:631-591-3000
Mailing Address - Fax:631-591-1734
Practice Address - Street 1:34 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3118
Practice Address - Country:US
Practice Address - Phone:631-591-3000
Practice Address - Fax:631-591-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty