Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA10601500 | NJ |
NPI | 1144563818 |
---|---|
Provider Name | Mark Ayzenberg |
First Address | Vineland, NJ 08360-5306 |
Second Address | Vineland, NJ 08360-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 05/03/2020 |