Provider Demographics
NPI:1447348248
Name:VAN ALSTYNE, MARK EDWARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWARD
Last Name:VAN ALSTYNE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2604
Mailing Address - Country:US
Mailing Address - Phone:212-305-3400
Mailing Address - Fax:212-342-3955
Practice Address - Street 1:60 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2604
Practice Address - Country:US
Practice Address - Phone:212-305-3400
Practice Address - Fax:212-342-3955
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant