Provider Demographics
NPI:1649399023
Name:BOOKMAN, DAVID MARK
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:BOOKMAN
Suffix:
Gender:M
Credentials:
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Other - Credentials:
Mailing Address - Street 1:80 STATE HIGHWAY 310
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1493
Mailing Address - Country:US
Mailing Address - Phone:315-386-2189
Mailing Address - Fax:315-386-2435
Practice Address - Street 1:1 CHIMNEY POINT DRIVE
Practice Address - Street 2:PRITCHARD PAVILION
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-393-1164
Practice Address - Fax:315-393-6461
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)