Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25MA02798000 | NJ |
N | 207Q00000X | Family Doctor | 25MA02798000 | NJ |
NPI | 1023082534 |
---|---|
Provider Name | Dr. Mark Abel |
First Address | Brick, NJ 08724-2804 |
Second Address | Brick, NJ 08724-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 25/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E52211 | (02) | NJ |