Individual
MARK STODDART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, ATC
Contact information
Practice address
69 FAIRFIELD AVE, MINEOLA, NY 11501-3335
(516) 640-5342
Mailing address
69 FAIRFIELD AVE, MINEOLA, NY 11501-3335
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001134-1
NY
Other
Enumeration date
10/28/2011
Last updated
10/28/2011
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