Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003468430 |
---|---|
Provider Name | Mark Eric Penn JR. |
First Address | New York, NY 10030-1013 |
Second Address | New York, NY 10030-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 16/07/2019 |