Basic Information
Provider Information
NPI: 1063702017
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADELMAN
FirstName: MARK
MiddleName: HOWARD
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 462 1ST AVE
Address2: NBV 7N24
City: NEW YORK
State: NY
PostalCode: 10016
CountryCode: US
TelephoneNumber: 2122636479
FaxNumber:  
Practice Location
Address1: 550 1ST AVE
Address2: NBV 16N30
City: NEW YORK
State: NY
PostalCode: 10016
CountryCode: US
TelephoneNumber: 2122635506
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2011
LastUpdateDate: 02/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X271323NYN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001X271323NYY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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