Provider Demographics
NPI:1821093840
Name:GVENTER, MARK (DPM, PC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GVENTER
Suffix:
Gender:M
Credentials:DPM, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 OCEAN PKWY
Mailing Address - Street 2:STE 403
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8014
Mailing Address - Country:US
Mailing Address - Phone:718-265-1140
Mailing Address - Fax:718-648-2211
Practice Address - Street 1:2965 OCEAN PKWY
Practice Address - Street 2:STE 403
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8014
Practice Address - Country:US
Practice Address - Phone:718-265-1140
Practice Address - Fax:718-648-2211
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002605213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00415018Medicaid
NY2210604OtherAETNA
NYP618996OtherOXFORD
NY0085809OtherGHI
NY1343406-005OtherCIGNA
NY4C7517OtherHEALTHNET
NY63679OtherUNITED HEALTHCARE
NYA400024901OtherMEDICARE PTAN
NY63679OtherUNITED HEALTHCARE
NY1343406-005OtherCIGNA
NYT71172Medicare UPIN
NY00415018Medicaid