MEDICARE: MARK TASBER PT

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	174400000X	Specialist	019131	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760422042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK TASBER PT

Provider Business Mailing Address
First Line	:	40 MAPLEWOOD DR
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13901
Country	:	US
Telephone Number	:	607-648-8052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2663 MAIN STREET
Second Line	:
City	:	WHITNEY POINT
State	:	NY
Zip	:	13862
Country	:	US
Telephone Number	:	607-692-4420
Fax Number	:	607-692-4415

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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