Provider Demographics
NPI:1184624611
Name:MARKO, MOSHE (PT)
Entity type:Individual
Prefix:MR
First Name:MOSHE
Middle Name:
Last Name:MARKO
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 1:6221 RTE 31
Mailing Address - Street 2:STE 103
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039
Mailing Address - Country:US
Mailing Address - Phone:315-699-1009
Mailing Address - Fax:315-699-1094
Practice Address - Street 1:6221 RTE 31
Practice Address - Street 2:STE 103
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-699-1009
Practice Address - Fax:315-699-1094
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019301-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6323Medicare ID - Type Unspecified
P89442Medicare UPIN