Individual
DR. MARK ALAN KOENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
765 ROUTE 25A STE 6, MILLER PLACE, NY 11764-2649
(631) 320-3200
(631) 350-7798
Mailing address
1 E ROE BLVD, PATCHOGUE, NY 11772-2631
(631) 475-3900
(631) 866-8150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
174687
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01263721
—
NY
Enumeration date
12/19/2006
Last updated
08/16/2019
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