Provider Demographics
NPI:1437179124
Name:FARRELL, MARK (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:243 NORTH RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1172
Mailing Address - Country:US
Mailing Address - Phone:845-451-7251
Mailing Address - Fax:845-451-7757
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1172
Practice Address - Country:US
Practice Address - Phone:845-790-6100
Practice Address - Fax:845-345-9966
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-04-23
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Provider Licenses
StateLicense IDTaxonomies
NY003835363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02419652Medicaid
NY02419652Medicaid