Individual
MR. MARC THOMAS CIVITANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
600 MAMARONECK AVE, SUITE 101, HARRISON, NY 10528-1635
(914) 686-0111
(914) 686-8964
Mailing address
600 MAMARONECK AVE, SUITE 101, HARRISON, NY 10528-1635
(914) 686-0111
(914) 686-8964
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
011059
NY
Other
Enumeration date
01/17/2007
Last updated
07/30/2013
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