Provider Demographics
NPI:1013901024
Name:FLUGMAN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FLUGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 N VILLAGE AVE
Mailing Address - Street 2:SUITE # 2A
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3800
Mailing Address - Country:US
Mailing Address - Phone:516-766-6400
Mailing Address - Fax:516-766-6457
Practice Address - Street 1:176 N VILLAGE AVE
Practice Address - Street 2:SUITE # 2A
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-766-6400
Practice Address - Fax:516-766-6457
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2019-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY141643207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAS677OtherOXFORD ID #
NY0092460OtherGHI ID #
NY00831829Medicaid
NY0098128OtherAETNA US HEALTHCARE #
NY6531OtherVYTRA ID #
NYAS677OtherOXFORD ID #
NY0098128OtherAETNA US HEALTHCARE #
NY08D891Medicare PIN