Healthcare Provider Details

I. General information

NPI: 1053341438
Provider Name (Legal Business Name): MARK EPHRAIM SOLOMON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 RIDGEDALE AVE STE 101
CEDAR KNOLLS NJ
07927-2109
US

IV. Provider business mailing address

218 RIDGEDALE AVE STE 101
CEDAR KNOLLS NJ
07927-2109
US

V. Phone/Fax

Practice location:
  • Phone: 973-538-7700
  • Fax: 973-538-9478
Mailing address:
  • Phone: 973-538-7700
  • Fax: 973-538-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00268100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: