Individual
MARK STEPHEN LICCINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
93 COOPER RD STE 100, VOORHEES, NJ 08043-4910
(856) 770-1920
(856) 770-1925
Mailing address
31 WIMBLEDON WAY, MARLTON, NJ 08053-2087
(215) 205-4231
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MB 07743500
NJ
Other
Enumeration date
11/08/2006
Last updated
02/05/2024
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