Provider Demographics
NPI:1699915306
Name:MARK, ERIKA BETH (DO)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:BETH
Last Name:MARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:BETH
Other - Last Name:MARK-NEYRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:181 OLD COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514
Mailing Address - Country:US
Mailing Address - Phone:516-248-5437
Mailing Address - Fax:516-248-5452
Practice Address - Street 1:181 OLD COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514
Practice Address - Country:US
Practice Address - Phone:516-248-5437
Practice Address - Fax:516-248-5452
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY255814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program