Provider Demographics
NPI:1215964119
Name:OCONNELL, MARK E (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:65 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-723-8135
Mailing Address - Fax:607-723-4202
Practice Address - Street 1:65 PENNSYLVANIA AVE STE 100
Practice Address - Street 2:HEALTH FITNESS & REHAB
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-723-8135
Practice Address - Fax:607-723-4202
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0158711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC4889Medicare ID - Type Unspecified