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General NPI Number Information
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NPI Number | 1891130167
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Entity Type | Individual
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Provider Name | MARK BUENZLE
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Gender | Male
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 16 W 10TH ST CENTER FOR MODERN PSYCHOANALYTIC STUDIES
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City | NEW YORK
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State | NY
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Zip | 10011-8707
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Country | US
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Telephone | 917-478-0677
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Fax |
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Provider Business Mailing Address
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Address Line | 294 BRONXVILLE RD 5G
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City | BRONXVILLE
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State | NY
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Zip | 10708-2850
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Country | US
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Telephone | 917-478-0677
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 000894-1
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License Number State | NY
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