Provider Demographics
NPI:1922270883
Name:MARK E PRUZANSKY MD PC
Entity Type:Organization
Organization Name:MARK E PRUZANSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETITO
Authorized Official - Suffix:
Authorized Official - Credentials:PA/C
Authorized Official - Phone:212-249-8700
Mailing Address - Street 1:975 PARK AVE
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0323
Mailing Address - Country:US
Mailing Address - Phone:212-249-8700
Mailing Address - Fax:212-327-4405
Practice Address - Street 1:975 PARK AVE
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0323
Practice Address - Country:US
Practice Address - Phone:212-249-8700
Practice Address - Fax:212-327-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009911261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty