Basic Information
| Provider Information | |||||||||
| NPI: | 1336209477 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KISSIN | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | LIJMC DEPT. OF SURGERY VASCULAR SURGERY | ||||||||
| Address2: | LIJMC DEPT. OF SURGERY VASCULAR SURGERY | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707210 | ||||||||
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| Practice Location | |||||||||
| Address1: | LIJMC DEPT. OF SURGERY VASCULAR SURGERY | ||||||||
| Address2: | 270 05 76TH AVENUE | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 224803 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.