Provider Demographics
NPI:1821187790
Name:VANALSTYNE, MARK (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:VANALSTYNE
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 E GENESEE ST
Mailing Address - Street 2:BLDG A LOWER LEVEL
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1131
Mailing Address - Country:US
Mailing Address - Phone:315-445-4835
Mailing Address - Fax:315-445-4836
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BLDG A LOWER LEVEL
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-445-4835
Practice Address - Fax:315-445-4836
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027302225100000X
NY009590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0807Medicare ID - Type Unspecified
NYBB9195Medicare ID - Type Unspecified
NYU78912Medicare UPIN