Provider Demographics
NPI:1023347473
Name:DARWISH, MENACHEM MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MENACHEM
Middle Name:MARK
Last Name:DARWISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 4TH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1506
Mailing Address - Country:US
Mailing Address - Phone:917-674-8272
Mailing Address - Fax:
Practice Address - Street 1:14102 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1618
Practice Address - Country:US
Practice Address - Phone:917-674-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist