Provider Demographics
NPI:1588249262
Name:MARK L SARNOV MD PLLC
Entity type:Organization
Organization Name:MARK L SARNOV MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:SARNOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-684-3556
Mailing Address - Street 1:1379 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2412
Mailing Address - Country:US
Mailing Address - Phone:585-684-3556
Mailing Address - Fax:585-360-1701
Practice Address - Street 1:1379 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2412
Practice Address - Country:US
Practice Address - Phone:585-684-3556
Practice Address - Fax:585-360-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777619Medicaid