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General NPI Number Information
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NPI Number | 1790204071
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Entity Type | Individual
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Provider Name | MARK HATTON LPN
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Gender | Male
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 26 DUMONT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1450
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Country | US
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Telephone | 718-667-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 WARREN ST
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City | ROSELLE
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State | NJ
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Zip | 07203-2737
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Country | US
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Telephone |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 329533
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License Number State | NY
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