Provider Demographics
NPI:1518439199
Name:WEEKES, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:WEEKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12301-1327
Mailing Address - Country:US
Mailing Address - Phone:518-419-7500
Mailing Address - Fax:
Practice Address - Street 1:1570 HELDERBERG AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-4632
Practice Address - Country:US
Practice Address - Phone:518-419-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY992221613347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker