Individual
DR. MARK GUDESBLATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3939
(631) 666-3994
Mailing address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3939
(631) 666-3994
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
147227
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01158790
—
NY
Enumeration date
02/06/2006
Last updated
09/13/2016
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