Individual
BLANE ALDEN MARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
475 NORTHERN BLVD STE 11, GREAT NECK, NY 11021-4802
(516) 829-0030
(516) 466-7723
Mailing address
475 NORTHERN BLVD STE 27, GREAT NECK, NY 11021-4802
(516) 829-0030
(516) 466-7723
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
043264
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043264
LICENSE NUMBER
PA
Enumeration date
08/21/2018
Last updated
02/13/2019
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