Basic Information
Provider Information | |||||||||
NPI: | 1629019203 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARKS | ||||||||
FirstName: | VICTOR | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.P.M. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 550 MAMARONECK AVE | ||||||||
Address2: | SUITE 302 | ||||||||
City: | HARRISON | ||||||||
State: | NY | ||||||||
PostalCode: | 105281634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9147238100 | ||||||||
FaxNumber: | 9142191928 | ||||||||
Practice Location | |||||||||
Address1: | 600 MAMARONECK AVE | ||||||||
Address2: | SUITE 101 | ||||||||
City: | HARRISON | ||||||||
State: | NY | ||||||||
PostalCode: | 105281635 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9147238100 | ||||||||
FaxNumber: | 9142191928 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/08/2006 | ||||||||
LastUpdateDate: | 02/10/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 2561 | NY | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist |   |
ID Information
ID | Type | State | Issuer | Description | 132977342 | 01 | NY | POMCO | OTHER | DR4232 | 01 | NY | OXFORD | OTHER | 1C4459 | 01 | NY | HEALTHNET | OTHER |