Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25MB07694400 | NJ |
NPI | 1063482651 |
---|---|
Provider Name | Mark Karolak |
First Address | Brick, NJ 08724-7770 |
Second Address | Brick, NJ 08724-7770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33076 | (02) | NJ |