Organization
KENNETH MARK MD PC
Active
Parent organization
KENNETH MARK M.D. PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENNETH MARK M.D. PC
Authorized official
DR. KENNETH ANDRE MARK MD (PHYSICIAN)
(631) 283-0002
Entity
Organization
Contact information
Practice address
425 COUNTY ROAD 39A, SUITE 201, SOUTHAMPTON, NY 11968-5277
(631) 283-0002
(631) 283-1932
Mailing address
PO BOX 175, WATER MILL, NY 11976-0175
(631) 283-0002
(631) 283-1932
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
204164
NY
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
204164
NY
207NS0135X
Procedural Dermatology Physician
204164
NY
Other
Enumeration date
01/23/2008
Last updated
04/03/2013
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