Provider Demographics
NPI:1740301100
Name:MARKS, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1185 PARK AVENUE
Mailing Address - Street 2:#1C 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1310
Mailing Address - Country:US
Mailing Address - Phone:212-722-6613
Mailing Address - Fax:212-722-6835
Practice Address - Street 1:1185 PARK AVENUE
Practice Address - Street 2:#1C 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1310
Practice Address - Country:US
Practice Address - Phone:212-722-6613
Practice Address - Fax:212-722-6835
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYMD124146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C05526Medicare UPIN
11A491Medicare ID - Type Unspecified