Individual
MARY MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
175 REMSEN ST STE 750, BROOKLYN, NY 11201-4382
(718) 522-7300
Mailing address
3711 35TH AVE STE 3C, ASTORIA, NY 11101-1441
(718) 706-7500
(718) 706-9595
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
206949031
NY
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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