Provider Demographics
NPI:1962682724
Name:OLLINGER, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:OLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E 95TH ST
Mailing Address - Street 2:#5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 E 95TH ST
Practice Address - Street 2:#5D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0705
Practice Address - Country:US
Practice Address - Phone:917-859-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist