| Organization Name: | MARK A. KOENIG, D.O., P.C. |
| NPI Number: | 1265708374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK ALAN KOENIG (PRESIDENT) |
| Mailing Address: | 606 Middle Country Rd Suite 1 Middle Island |
| State: | NY US |
| Postal Code: | 119532556 |
| Phone Number: | 6319245060 |
| Fax Number: | 6319248690 |
| NPI Enumeration Date: | 03/23/2012 |
| NPI Last Update Date: | 03/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 174687 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |