Individual
MARK PATRICK FULLENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 ROBERT WOOD JOHNSON PL, NEW BRUNSWICK, NJ 08901-1928
(732) 937-8841
(732) 418-8492
Mailing address
66 W GILBERT ST, 2ND FLOOR, TINTON FALLS, NJ 07701-4947
(732) 212-0051
(732) 212-0713
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA08100300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00412626
RR MCR PTAN
NJ
Enumeration date
07/23/2006
Last updated
10/29/2009
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