Provider Demographics
NPI:1184899551
Name:MACK, DARREN M (RPA-C)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:M
Last Name:MACK
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:125 LINCOLN AVE APT B4L
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2837
Mailing Address - Country:US
Mailing Address - Phone:516-728-7846
Mailing Address - Fax:516-739-5441
Practice Address - Street 1:125 LINCOLN AVE APT B4L
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2837
Practice Address - Country:US
Practice Address - Phone:516-728-7846
Practice Address - Fax:516-739-5441
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005977-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical