Healthcare Provider Details

I. General information

NPI: 1962574392
Provider Name (Legal Business Name): MARK SCHUR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N BROADWAY
NORTH MASSAPEQUA NY
11758-2348
US

IV. Provider business mailing address

727 N BROADWAY STE A1
MASSAPEQUA NY
11758-2348
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-8090
  • Fax:
Mailing address:
  • Phone: 516-798-8090
  • Fax: 516-795-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0088201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: