Provider Demographics
NPI:1861644171
Name:PLEXOUSAKIS, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PLEXOUSAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:ATTN: RIVERSIDE MANAGEMENT SERVICES ORG.
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-0998
Mailing Address - Country:US
Mailing Address - Phone:914-966-9787
Mailing Address - Fax:914-966-9793
Practice Address - Street 1:967 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1301
Practice Address - Country:US
Practice Address - Phone:914-966-9787
Practice Address - Fax:914-966-9793
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250199207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine