Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004925 | NY |
Y | 222Z00000X | Podiatrist | N004925 | NY |
NPI | 1033217112 |
---|---|
Provider Name | Dr. Mark H Wells |
First Address | Suffern, NY 10901 |
Second Address | Suffern, NY 10901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U32677 | (02) |