Basic Information
| Provider Information | |||||||||
| NPI: | 1093702730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIR | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | EHUD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3311 SHORE PKWY | ||||||||
| Address2: | APT FF | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112353937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 7189219349 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 VOORHIES AVENUE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 7186480411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 01/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 013940-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | AM3940 | 01 | NY | ATLANTIS HEALTH PLAN | OTHER | 175543 | 01 | NY | ELDERPLAN | OTHER | 20587P | 01 | NY | HIP | OTHER | 02203285 | 05 | NY | MEDICAID | P2522968 | 01 | NY | OXFORD | OTHER | 2C6646 | 01 | NY | HEALTH NET | OTHER | 6699902 | 01 | NY | GHI | OTHER |