Provider Demographics
NPI:1689897456
Name:NEWMARK, JEFFREY LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:NEWMARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4315
Mailing Address - Country:US
Mailing Address - Phone:515-883-3411
Mailing Address - Fax:212-645-2710
Practice Address - Street 1:5 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3543
Practice Address - Country:US
Practice Address - Phone:212-645-1395
Practice Address - Fax:212-645-2710
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist