Provider Demographics
NPI:1457426876
Name:FIERSTEIN, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:FIERSTEIN
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 1:2001 MARCUS AVE STE S265
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1035
Mailing Address - Country:US
Mailing Address - Phone:516-686-0500
Mailing Address - Fax:646-754-7508
Practice Address - Street 1:2001 MARCUS AVE STE S265
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1035
Practice Address - Country:US
Practice Address - Phone:516-686-0500
Practice Address - Fax:646-754-7508
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A63722Medicare UPIN
670071Medicare ID - Type Unspecified