Provider Demographics
NPI:1891130167
Name:BUENZLE, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BUENZLE
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 1:294 BRONXVILLE RD
Mailing Address - Street 2:5G
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2850
Mailing Address - Country:US
Mailing Address - Phone:917-478-0677
Mailing Address - Fax:
Practice Address - Street 1:16 W 10TH ST
Practice Address - Street 2:CENTER FOR MODERN PSYCHOANALYTIC STUDIES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8707
Practice Address - Country:US
Practice Address - Phone:917-478-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000894-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst