Healthcare Provider Details

I. General information

NPI: 1205818689
Provider Name (Legal Business Name): MARK SKRZYPCZAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 302
AVENEL NJ
07001-1330
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 302
AVENEL NJ
07001-1330
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-1200
  • Fax: 732-669-9899
Mailing address:
  • Phone: 732-750-1200
  • Fax: 732-669-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04727400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: