Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 25MA07791500 | NJ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 25MA07791500 | NJ |
NPI | 1265516488 |
---|---|
Provider Name | Dr. George E Mark |
First Address | Haddon Heights, NJ 08035-1927 |
Second Address | Haddon Heights, NJ 08035-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8825904 | (05) | NJ |
H59157 | (02) | NJ |