Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 239997 | NY |
Y | 207Q00000X | Family Doctor | 239997 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | 239997 | NY |
NPI | 1144251729 |
---|---|
Provider Name | Dr. Mark Sethna |
First Address | Hicksville, NY 11801-3233 |
Second Address | Hicksville, NY 11801-3233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 20/03/2012 |