Provider Demographics
NPI:1679030118
Name:BAILEY, MARK BORIS (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BORIS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WESTCHESTER AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3585
Mailing Address - Country:US
Mailing Address - Phone:646-350-0033
Mailing Address - Fax:855-326-6768
Practice Address - Street 1:2510 WESTCHESTER AVE STE 207
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3585
Practice Address - Country:US
Practice Address - Phone:646-350-0033
Practice Address - Fax:855-326-6768
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017843183500000X
NY059041-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist