Provider Demographics
NPI:1962642108
Name:GARMISE, MARK ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:GARMISE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SMITHTOWN BYP STE 110
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2512
Mailing Address - Country:US
Mailing Address - Phone:631-406-7716
Mailing Address - Fax:347-732-9862
Practice Address - Street 1:111 SMITHTOWN BYP STE 110
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2512
Practice Address - Country:US
Practice Address - Phone:631-406-7716
Practice Address - Fax:631-406-7717
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-28
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCO004619222Z00000X
NY026434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist