Individual
DR. MARK J IVANICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 ROE AVENUE, SUITE 4A, ELMIRA, NY 14905-1629
(607) 271-3780
(607) 271-3894
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
(607) 873-1244
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
139254
NY
207RP1001X
Pulmonary Disease Physician
Primary
NY139254-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001003160
—
PA
05
—
00650211
—
NY
Enumeration date
09/30/2005
Last updated
11/25/2020
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