MEDICARE: DR. MARK A NACHMIAS PHD

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	103T00000X	Psychologist	86331	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	166476	OTHER	ELDERPLAN
2	0012428	OTHER	VALUE OPTIONS
3	224392	OTHER	MHN
4	144093	OTHER	EMPIRE VALUE OPTIONS
5	40593P	OTHER	HIP

General Provider Information

NPI Number	:	1699875344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A NACHMIAS PHD

Provider Business Mailing Address
First Line	:	3915 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3425
Country	:	US
Telephone Number	:	718-948-7800
Fax Number	:	718-948-1733

Provider Business Practice Location Address
First Line	:	3915 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3425
Country	:	US
Telephone Number	:	718-948-7800
Fax Number	:	718-948-7800

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. MARK A NACHMIAS PHD” Practice Location

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