1386647741 NPI number — MARK E HOWARD P.T.,D.P.T.,O.C.S.

Table of content: MARK E HOWARD P.T.,D.P.T.,O.C.S. (NPI 1386647741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386647741 NPI number — MARK E HOWARD P.T.,D.P.T.,O.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
MARK
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.,D.P.T.,O.C.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386647741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4721 TRANSIT RD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
DEPEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14043-4898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-675-4444
Provider Business Mailing Address Fax Number:
716-675-4446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4721 TRANSIT RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
DEPEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14043-4898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-675-4444
Provider Business Practice Location Address Fax Number:
716-675-4446
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  009241 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650018170 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 809602 . This is a "ACN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011174401 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000610297001 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9308094 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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