Provider Demographics
NPI:1760432082
Name:WILNER, MARK C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:WILNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20 WATERSIDE PLZ
Mailing Address - Street 2:APT. 32 J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2612
Mailing Address - Country:US
Mailing Address - Phone:212-685-5282
Mailing Address - Fax:212-685-5945
Practice Address - Street 1:942 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2656
Practice Address - Country:US
Practice Address - Phone:212-535-2221
Practice Address - Fax:212-249-5463
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY152261208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00960650Medicaid
NY69D101OtherPROVIDER NUMBER
NY152261OtherLICENCE NUMBER
NYAW1913830OtherDEA
NY00960650Medicaid