MEDICARE: DR. MARK E WERTENTEIL M.D.

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	207R00000X	Internal Medicine Physician	64782	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P626640	OTHER	OXFORD
2	1750922	OTHER	UNITEDHEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5240557	OTHER	AETNA
5	0464052000	OTHER	AMERIHEALTH

General Provider Information

NPI Number	:	1922067180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E WERTENTEIL M.D.

Provider Business Mailing Address
First Line	:	85 HARRISTOWN RD
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3329
Country	:	US
Telephone Number	:	201-689-3726
Fax Number	:	201-794-2117

Provider Business Practice Location Address
First Line	:	85 HARRISTOWN RD
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3329
Country	:	US
Telephone Number	:	201-689-3726
Fax Number	:	201-794-2117

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/03/2025

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