Provider Demographics
NPI:1184959074
Name:SMALEC, MARK S (JD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:SMALEC
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:DOVER PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12522
Mailing Address - Country:US
Mailing Address - Phone:845-877-6372
Mailing Address - Fax:845-877-6524
Practice Address - Street 1:3184 ROUTE 22
Practice Address - Street 2:
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522-5924
Practice Address - Country:US
Practice Address - Phone:845-877-6372
Practice Address - Fax:845-877-6524
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY033564-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist