Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00168300 | NJ |
NPI | 1003953902 |
---|---|
Provider Name | Dr. Mark Guariglia |
First Address | Point Pleasant Boro, NJ 08742-4970 |
Second Address | Point Pleasant Boro, NJ 08742-4970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
223394419 | TAX IDENTIFICATION NUMBER (01) | NJ |