Provider Demographics
NPI:1184721078
Name:KRAMER, MARK MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MICHAEL
Last Name:KRAMER
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 1:1075 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE: 307
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3242
Mailing Address - Country:US
Mailing Address - Phone:914-337-5956
Mailing Address - Fax:914-337-6055
Practice Address - Street 1:1075 CENTRAL PARK AVE
Practice Address - Street 2:SUITE: 307
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3242
Practice Address - Country:US
Practice Address - Phone:914-337-5956
Practice Address - Fax:914-337-6055
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133160287OtherTAX ID#
NY54A671Medicare ID - Type UnspecifiedMEDICARE ID#
NYC11124Medicare UPIN