Provider Demographics
NPI:1326043258
Name:CUKIERMAN, MARK STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:CUKIERMAN
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 1:7445 FENWICK PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1308
Mailing Address - Country:US
Mailing Address - Phone:917-697-9883
Mailing Address - Fax:
Practice Address - Street 1:7445 FENWICK PL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1308
Practice Address - Country:US
Practice Address - Phone:917-697-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50376207R00000X
NY167745207R00000X
FLME82479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDI903AOtherMEDICARE PTAN
NJC54820Medicare UPIN
NJCU446935Medicare ID - Type Unspecified