MEDICARE: MARK PERNICE D.O.

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	207Q00000X	Family Medicine Physician	25MB04100800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010640	OTHER	NJ	US HEALTHCARE
2	0100759001	OTHER	NJ	AMERIHEALTH
3	156502908	OTHER	NJ	UNITED HEALTHCARE
4	F09371	OTHER	NJ	HEALTHNET
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	NJ41008	OTHER	NJ	MUTUAL OF OMAHA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811940620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PERNICE D.O.

Provider Business Mailing Address
First Line	:	2106 NEW RD
Second Line	:	SUITE D1
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1050
Country	:	US
Telephone Number	:	609-927-9545
Fax Number	:	609-927-2920

Provider Business Practice Location Address
First Line	:	2106 NEW RD
Second Line	:	SUITE D1
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1050
Country	:	US
Telephone Number	:	609-927-9545
Fax Number	:	609-927-2920

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/19/2011

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Directions to “ MARK PERNICE D.O.” Practice Location

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