Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004293-1 | NY |
Y | 222Z00000X | Podiatrist | N004293-1 | NY |
NPI | 1053320499 |
---|---|
Provider Name | Mark Charles Durkin |
First Address | Lakeville, NY 14480-9720 |
Second Address | Lakeville, NY 14480-9720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |