Provider Demographics
NPI:1396846556
Name:OPFER, MARK ANDY (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDY
Last Name:OPFER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIDEN LN
Mailing Address - Street 2:SUITE 801
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4810
Mailing Address - Country:US
Mailing Address - Phone:646-312-6221
Mailing Address - Fax:212-269-2905
Practice Address - Street 1:745 7TH AVE
Practice Address - Street 2:21ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6801
Practice Address - Country:US
Practice Address - Phone:646-312-6288
Practice Address - Fax:212-269-2905
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
025267-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q20X31Medicare PIN