Provider Demographics
NPI:1528233756
Name:PINKHASOV, MARK M (DO, PHARM-D)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:PINKHASOV
Suffix:
Gender:M
Credentials:DO, PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:116 BUSINESS PARK DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6313
Mailing Address - Country:US
Mailing Address - Phone:315-624-7000
Mailing Address - Fax:315-793-1129
Practice Address - Street 1:116 BUSINESS PARK DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6313
Practice Address - Country:US
Practice Address - Phone:315-624-7000
Practice Address - Fax:315-793-1129
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY051502183500000X
NY276158207R00000X, 207RG0100X
NJ25MB09512800207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No183500000XPharmacy Service ProvidersPharmacist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400595789OtherMEDICARE
NY02981868Medicaid