Provider Demographics
NPI:1043637457
Name:SCELZA, MARK A (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:SCELZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6268 JERICHO TPKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2810
Mailing Address - Country:US
Mailing Address - Phone:631-499-6944
Mailing Address - Fax:631-499-6951
Practice Address - Street 1:6268 JERICHO TPKE
Practice Address - Street 2:SUITE 6
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2810
Practice Address - Country:US
Practice Address - Phone:631-499-6944
Practice Address - Fax:631-499-6951
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX010516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor