Provider Demographics
NPI:1104820018
Name:KROPF, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KROPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BELLE TERRE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1928
Mailing Address - Country:US
Mailing Address - Phone:631-331-6090
Mailing Address - Fax:631-474-7855
Practice Address - Street 1:200 BELLE TERRE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1928
Practice Address - Country:US
Practice Address - Phone:631-331-6090
Practice Address - Fax:631-474-7855
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-03-28
Deactivation Date:2006-03-28
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NY60-166236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01103373Medicaid
NYA63918Medicare UPIN
NY01103373Medicaid