Provider Demographics
NPI:1790985216
Name:BATES, ERIC MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARK
Last Name:BATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:101 W 106TH ST
Mailing Address - Street 2:3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3713
Mailing Address - Country:US
Mailing Address - Phone:212-933-4192
Mailing Address - Fax:212-933-4192
Practice Address - Street 1:101 W 106TH ST
Practice Address - Street 2:3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3713
Practice Address - Country:US
Practice Address - Phone:212-933-4192
Practice Address - Fax:212-933-4192
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0617299Medicaid
NY0617299Medicaid