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General NPI Number Information
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NPI Number | 1578502779
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Entity Type | Individual
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Provider Name | MARK WILLIAM HENRY MS, RPA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 205 S ORANGE AVE C-LEVEL #1200
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City | NEWARK
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State | NJ
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Zip | 07103-2785
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Country | US
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Telephone | 973-972-8240
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Fax | 973-972-9367
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Provider Business Mailing Address
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Address Line | 205 S ORANGE AVE C-LEVEL #1200
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City | NEWARK
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State | NJ
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Zip | 07103-2785
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Country | US
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Telephone | 973-972-6500
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Fax | 973-972-9367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015279
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1098952
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00331900
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License Number State | NJ
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