Healthcare Provider Details

I. General information

NPI: 1770051179
Provider Name (Legal Business Name): DR. MARK STREIFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25232 WADDINGHAM RD
EVANS MILLS NY
13637-3148
US

IV. Provider business mailing address

25232 WADDINGHAM RD
EVANS MILLS NY
13637-3148
US

V. Phone/Fax

Practice location:
  • Phone: 131-577-8909
  • Fax:
Mailing address:
  • Phone: 131-577-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: