MEDICARE: MARK JOHN HAINES ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MT00001900	NJ

General Provider Information

NPI Number	:	1215294962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOHN HAINES ATC

Provider Business Mailing Address
First Line	:	14 LANCASHIRE DRIVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-3275
Country	:	US
Telephone Number	:	609-261-8824
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 JACKSONVILLE ROAD
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1239
Country	:	US
Telephone Number	:	609-267-0837
Fax Number	:	609-702-0835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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Directions to “ MARK JOHN HAINES ATC” Practice Location

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