Provider Demographics
NPI:1699875344
Name:NACHMIAS, MARK A (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:NACHMIAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3425
Mailing Address - Country:US
Mailing Address - Phone:718-948-7800
Mailing Address - Fax:718-948-1733
Practice Address - Street 1:3915 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3425
Practice Address - Country:US
Practice Address - Phone:718-948-7800
Practice Address - Fax:718-948-7800
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
166476OtherELDERPLAN
0012428OtherVALUE OPTIONS
224392OtherMHN
144093OtherEMPIRE VALUE OPTIONS
40593POtherHIP
224392OtherMHN