Individual
MARK MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
201 LYONS AVE, SUITE L5, NEWARK, NJ 07112-2027
(973) 926-3500
Mailing address
201 LYONS AVE, L5, NEWARK, NJ 07112-2027
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MB08737300
NJ
2080P0202X
Pediatric Cardiology Physician
Primary
25MB09737300
NJ
Other
Enumeration date
06/23/2009
Last updated
05/02/2024
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