Provider Demographics
NPI:1447332788
Name:CAFFREY, MARK (AUD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CAFFREY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-4617
Mailing Address - Country:US
Mailing Address - Phone:518-725-2620
Mailing Address - Fax:518-725-4466
Practice Address - Street 1:182 STEELE AVE
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-4617
Practice Address - Country:US
Practice Address - Phone:518-725-2620
Practice Address - Fax:518-725-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001211231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54004BMedicare ID - Type UnspecifiedPROVIDER NUMBER