Provider Demographics
NPI:1861548950
Name:MARK SANDIGURSKY INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:MARK SANDIGURSKY INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDIGURSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-237-0959
Mailing Address - Street 1:875 YONKERS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3019
Mailing Address - Country:US
Mailing Address - Phone:914-237-0959
Mailing Address - Fax:914-375-4405
Practice Address - Street 1:875 YONKERS AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3019
Practice Address - Country:US
Practice Address - Phone:914-237-0959
Practice Address - Fax:914-375-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
193278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01728541Medicaid
NYG03766Medicare UPIN