Healthcare Provider Details

I. General information

NPI: 1831161751
Provider Name (Legal Business Name): MARK A RIEGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
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 TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA53039
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number64729
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number25MA05303900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: