Individual
MARK SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
750 PARK AVE, UNIONDALE, NY 11553-3225
(516) 303-2443
Mailing address
750 PARK AVE, UNIONDALE, NY 11553-3225
(516) 303-2443
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
616636652
—
NY
Enumeration date
09/28/2018
Last updated
09/28/2018
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