MARK J DECKER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036122034

License Status

NOT RENEWED

Business

Title

First Name

MARK

Middle

Last Name

DECKER

Business Name

MARK J DECKER MD

Original Issue Date

10/06/2008

Effective Date

07/20/2011

Expiration Date

07/31/2014

City

EAST SETAUKET

State

Zip

11733

County

NEW YORK

Ever Disciplined

LastModifiedDate

11/17/2014