Provider Demographics
NPI:1689847006
Name:MARK AVINOAM BITTON MD PC
Entity type:Organization
Organization Name:MARK AVINOAM BITTON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BITTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-997-1400
Mailing Address - Street 1:10025 QUEENS BLVD
Mailing Address - Street 2:APT 1M-L
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2454
Mailing Address - Country:US
Mailing Address - Phone:718-997-1400
Mailing Address - Fax:718-504-4353
Practice Address - Street 1:10025 QUEENS BLVD
Practice Address - Street 2:APT 1M-L
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2454
Practice Address - Country:US
Practice Address - Phone:718-997-1400
Practice Address - Fax:718-504-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153828207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00761688Medicaid
NYE42395Medicare UPIN
NY00761688Medicaid