Provider Demographics
NPI:1184769309
Name:FERRARO, MARK THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:FERRARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LIBERTY SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2400
Mailing Address - Country:US
Mailing Address - Phone:845-429-3100
Mailing Address - Fax:845-429-3100
Practice Address - Street 1:16 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-429-3100
Practice Address - Fax:845-429-3140
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2429-1111N00000X
NJ1885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO2429-1BOtherWORKER'S COMP NUMBER
NY0080028OtherGHI PROVIDER NUMBER
GAP00161968OtherPALMETTO MEDICARE #
NY125946OtherOPTUM HEALTH
NY125946OtherACN GROUP PROVIDER NUMBER
NY889675OtherAETNA-US HEALTHCARE #
NYX13951Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER