Provider Demographics
NPI:1922012707
Name:BOREK, MARK GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:BOREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:NICHOLS ROAD
Mailing Address - Street 2:CARDIOLOGY DIVISION, SUNY, HSC, T16-080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8167
Mailing Address - Country:US
Mailing Address - Phone:631-444-1060
Mailing Address - Fax:631-444-1054
Practice Address - Street 1:26 RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-444-9970
Practice Address - Fax:631-444-5247
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156922207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01297103Medicaid
NY01297103Medicaid
NYA60547Medicare UPIN