Provider Demographics
NPI:1811733322
Name:KVASSAY, MARK FRANCIS
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:FRANCIS
Last Name:KVASSAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SHADY DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5914
Mailing Address - Country:US
Mailing Address - Phone:607-768-2183
Mailing Address - Fax:
Practice Address - Street 1:120 MADISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2822
Practice Address - Country:US
Practice Address - Phone:315-426-3600
Practice Address - Fax:315-426-3605
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483773-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty