Provider Demographics
NPI:1588920540
Name:SURABIAN, MARK EDWARD (ABD, ATP)
Entity type:Individual
Prefix:PROF
First Name:MARK
Middle Name:EDWARD
Last Name:SURABIAN
Suffix:
Gender:M
Credentials:ABD, ATP
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Mailing Address - Street 1:5 FORDHAM HILL OVAL
Mailing Address - Street 2:14G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4854
Mailing Address - Country:US
Mailing Address - Phone:917-586-8000
Mailing Address - Fax:
Practice Address - Street 1:5 FORDHAM HILL OVAL
Practice Address - Street 2:14G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4854
Practice Address - Country:US
Practice Address - Phone:917-586-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRESNA CERTIFIED ATP225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner