MEDICARE: ANTHONEY MARK THOMAS MS IN EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1741122	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033464540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONEY MARK THOMAS MS IN EDUCATION

Provider Business Mailing Address
First Line	:	1424 EAST 101ST STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	347-792-7361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 E 101ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5508
Country	:	US
Telephone Number	:	347-792-7361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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