Ivanick, Mark J
Ivanick, Mark J is an individual health care provider with primary practice located at 600 Roe Avenue Suite 4A, Elmira NY 14905-1629. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Ivanick, Mark J can be contacted via phone (607) 271-3780.Contact Information
Primary practice address
600 Roe Avenue Suite 4A
Elmira NY 14905-1629
Phone: (607) 271-3780
Fax: (607) 271-3894
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 139254 | New York |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | NY139254-1 | New York |
Profile Details
| NPI number | 1629065198 |
|---|---|
| LBN Legal business name | Ivanick, Mark J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 30th, 2005 |
| Last updated | Nov 25th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629065198 | NPPES |
| Pennsylvania | MEDICAID | 001003160 | |
| Pennsylvania | MEDICAID | 00650211 |
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