Individual
DR. MARC MITNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
360 SPRINGFIELD AVE, SUMMIT, NJ 07901-4608
(908) 522-0761
(908) 926-2111
Mailing address
1 STUART CT, PINE BROOK, NJ 07058-9646
(973) 882-9736
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00109000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222236123
TAX ID
NJ
Enumeration date
08/04/2005
Last updated
12/12/2007
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