Healthcare Provider Details

I. General information

NPI: 1477653376
Provider Name (Legal Business Name): MARK ROBERT HONIG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 HILL BOULEVARD SUITE 204
JEFFERSON VALLEY NY
10535
US

IV. Provider business mailing address

463 BONNIE COURT
YORKTOWN HEIGHTS NY
10598
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-6224
  • Fax: 914-243-6899
Mailing address:
  • Phone: 914-245-7527
  • Fax: 914-243-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNYSLIC6318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: