Healthcare Provider Details

I. General information

NPI: 1699731562
Provider Name (Legal Business Name): MARK L MOKRZYCKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CRANBURY RD SUITE 219
EAST BRUNSWICK NJ
08816-4098
US

IV. Provider business mailing address

620 CRANBURY RD SUITE 219
EAST BRUNSWICK NJ
08816-4098
US

V. Phone/Fax

Practice location:
  • Phone: 732-651-0005
  • Fax: 732-651-0053
Mailing address:
  • Phone: 732-651-0005
  • Fax: 732-651-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA65991
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: