Provider Demographics
NPI:1649306218
Name:MARK D FROMER, MD PC
Entity type:Organization
Organization Name:MARK D FROMER, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:FROMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-832-9228
Mailing Address - Street 1:10933 71ST RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4850
Mailing Address - Country:US
Mailing Address - Phone:718-261-3366
Mailing Address - Fax:
Practice Address - Street 1:10933 71ST RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4850
Practice Address - Country:US
Practice Address - Phone:718-261-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4225570001Medicare NSC
NYW7Z642Medicare PIN
NYP00104252Medicare PIN
NY06108Medicare PIN