Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | RESNA CERTIFIED ATP | NY |
NPI | 1588920540 |
---|---|
Provider Name | Prof. Mark Edward Surabian |
First Address | Bronx, NY 10468-4854 |
Second Address | Bronx, NY 10468-4854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 04/04/2012 |