Provider Demographics
NPI:1578731527
Name:WILLIAMS, MARK (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:WILLIAMS
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:27 N MAIN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1314
Mailing Address - Country:US
Mailing Address - Phone:607-749-2219
Mailing Address - Fax:607-749-2286
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 2120
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:212-732-2100
Practice Address - Fax:212-732-2105
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY030077-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare UPIN
NYQ2222QA561Medicare PIN
NYQ4WFH1Medicare PIN