Provider Demographics
NPI:1982770814
Name:SMALL, MARK (MS RPA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SMALL
Suffix:
Gender:M
Credentials:MS RPA-C
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Mailing Address - Street 1:869 EAST 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3537
Mailing Address - Country:US
Mailing Address - Phone:347-750-5247
Mailing Address - Fax:
Practice Address - Street 1:423 EAST 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:212-951-3394
Practice Address - Fax:212-951-6825
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011650363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical