Provider Demographics
NPI:1346511995
Name:LUSK, MARK MACKAY (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MACKAY
Last Name:LUSK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MADISON AVE
Mailing Address - Street 2:5TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7419
Mailing Address - Country:US
Mailing Address - Phone:646-430-5717
Mailing Address - Fax:646-514-1972
Practice Address - Street 1:99 MADISON AVE
Practice Address - Street 2:5TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7419
Practice Address - Country:US
Practice Address - Phone:646-430-5717
Practice Address - Fax:646-514-1972
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist