Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00560700 | NJ |
NPI | 1275537961 |
---|---|
Provider Name | Dr. Adam David Mark |
First Address | Matawan, NJ 07747-3282 |
Second Address | Matawan, NJ 07747-3283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 27/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U77365 | (02) | NJ |