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NPI Code Detail

MEDICARE: MR. MARK SMALL MS RPA-C

MEDICARE: MR. MARK SMALL MS 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
1363AS0400XSurgical Physician Assistant011650NY

General Provider Information

NPI Number : 1982770814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK SMALL MS RPA-C
Provider Business Mailing Address
First Line : 869 EAST 38TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-3537
Country : US
Telephone Number : 347-750-5247
Fax Number :
Provider Business Practice Location Address
First Line : 423 EAST 23RD ST
Second Line :
City : NEW YORK
State : NY
Zip : 10010-5011
Country : US
Telephone Number : 212-951-3394
Fax Number : 212-951-6825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2006
Last Update Date : 07/08/2007

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