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Individual

MARK BANCHIK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
90-02 QUEENS BLVD, ELMHURST, NY 11373-4941
(718) 558-1870
Mailing address
744 W MICHIGAN AVE, JACKSON, MI 49201-1909
(517) 787-6440
(517) 787-4146

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
151864
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
151864
LIC
NY
Enumeration date
06/27/2006
Last updated
12/05/2013
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