MEDICARE: MR. MARK S L'EPLATTENIER RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	003758-1	NY

General Provider Information

NPI Number	:	1679563654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK S L'EPLATTENIER RPA-C

Provider Business Mailing Address
First Line	:	3365 DEMOTT AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-3410
Country	:	US
Telephone Number	:	516-826-1792
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5317
Country	:	US
Telephone Number	:	718-963-8884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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