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General NPI Number Information
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NPI Number | 1699409367
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Entity Type | Individual
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Provider Name | MARK MENSCH ATC
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Gender | Male
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Dates
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Enumeration Date | 07/10/2022
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Last Update Date | 07/10/2022
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Provider Practice Location Address
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Address Line | 630 MASTIC RD STE 4
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City | MASTIC BEACH
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State | NY
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Zip | 11951-1020
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Country | US
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Telephone | 631-281-3871
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 407
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City | MORICHES
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State | NY
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Zip | 11955-0407
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Country | US
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Telephone | 631-375-5241
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 000232
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License Number State | NY
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