Provider Demographics
NPI:1851444681
Name:DANIEL C MAUSNER MD AND MARK J KIRCHBLUM MD LLP
Entity Type:Organization
Organization Name:DANIEL C MAUSNER MD AND MARK J KIRCHBLUM MD LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MAUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-764-1303
Mailing Address - Street 1:2000 NORTH VILLAGE AVENUE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1001
Mailing Address - Country:US
Mailing Address - Phone:516-764-1303
Mailing Address - Fax:516-764-3618
Practice Address - Street 1:2000 NORTH VILLAGE AVENUE
Practice Address - Street 2:SUITE 211
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1001
Practice Address - Country:US
Practice Address - Phone:516-764-1303
Practice Address - Fax:516-764-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125529207RG0100X
NY125940207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08A011Medicare ID - Type Unspecified
NY29A141Medicare ID - Type Unspecified
A98874Medicare UPIN
B12293Medicare UPIN