MARC BRETT MISHKIN (NPI# 1609982768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609982768 |
| Entity Type | Individual |
| Full Name | MARC BRETT MISHKIN |
| Credential | MD |
| Practice Address |
300 West Ave Brockport NY 14420-1118 |
| Mailing Address |
745 Post Rd The Healthy Child Darien CT 06820 |
| Practice Telephone | 5856373905 |
| Practice Fax Number | 5856374990 |
| Mailing Telephone | 2036556000 |
| Mailing Fax Number | 2036556003 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2015-05-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 241051 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | CAQH # | 10449602 | 01 |
| Street Address |
300 WEST AVE |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790749471 | Robert William Ford | Optometrist | 300 West Ave, Oak Orchard Community Health Center, Brockport, NY 14420 | 2006-04-12 |
| 1275003659 | Kimberly Sue Walitzer | Psychologist | 300 West Ave, Brockport, NY 14420-1118 | 2018-11-28 |
| 1720599533 | Erin Elisabeth Goodrich | Dietitian, Registered | 300 West Ave, Brockport, NY 14420-1118 | 2017-10-19 |
| 1790224335 | Valerie Mostyn | Social Worker | 300 West Ave, Brockport, NY 14420-1118 | 2017-02-15 |
| 1316485378 | Christina Smith | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2017-02-09 |
| 1447606215 | Chanh Huynh | Family Medicine | 300 West Ave, Brockport, NY 14420 | 2016-05-10 |
| 1851755664 | Tammy L Cornelius | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2016-04-07 |
| 1962890608 | Katherine Ann Trawick | Dentist | 300 West Ave, Brockport, NY 14420-1118 | 2015-01-05 |
| 1336537562 | Catherine Goetz | Physician Assistant | 300 West Ave, Brockport, NY 14420-1118 | 2014-12-22 |
| 1538592258 | Kelsey Eleanor Miller | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2013-08-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013984814 | David M Tinkelman Md PC | Pediatrics | 6 Sweden Ln, Brockport, NY 14420-2516 | 2006-03-01 |
| 1538592258 | Kelsey Eleanor Miller | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2013-08-16 |
| 1548569916 | Danielle Renodin-mead | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2011-03-24 |
| 1356671812 | David Martin Tinkelman | Pediatrics | 6 Sweden Ln, Brockport, NY 14420-2516 | 2010-01-06 |
| 1336183318 | James Peter Goetz | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2006-06-16 |
| 1568406015 | David Irwin Smith | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2006-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518577550 | Danielle Vann | Pediatrics | 151 N Washington St # 2s, Sleepy Hollow, NY 10591-3117 | 2020-08-04 |
| 1699392357 | Long Island Pediatrics of Patchogue PC | Pediatrics | 475 E Main St Ste 109, Patchogue, NY 11772-3121 | 2020-06-29 |
| 1811510811 | Dr Pediatric PC | Pediatrics | 38 Hopewell Dr, Stony Brook, NY 11790-2339 | 2020-05-26 |
| 1598386864 | Sandra Howard Bonat | Pediatrics | 4 Filomena Ct, Dix Hills, NY 11746-4750 | 2020-04-28 |
| 1497374359 | Medical Health 360 Pllc | Pediatrics | 16955 County Route 59, Dexter, NY 13634-2027 | 2020-04-10 |
| 1922633007 | Danzi & Hajduk-bennett Pediatrics Pllc | Pediatrics | 994 W Jericho Tpke Ste 202, Smithtown, NY 11787-3234 | 2020-03-09 |
| 1396377180 | Chelsea Oberkrieser | Pediatrics | 17 Long Ave Ste 110, Hamburg, NY 14075-6200 | 2020-02-10 |
| 1619508900 | Total Care Pediatrics Pllc | Pediatrics | 4265 Kissena Blvd # L4, Flushing, NY 11355-3273 | 2020-01-27 |
| 1639709157 | Decerina Uy Md PC | Pediatrics | 649 Route 25a Ste 3, Rocky Point, NY 11778-8983 | 2020-01-23 |
| 1447890603 | Opear Holdings, Inc | Pediatrics | 2635 Frances St, Bellmore, NY 11710-5401 | 2020-01-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.