Healthcare Provider Details

I. General information

NPI: 1982204939
Provider Name (Legal Business Name): MARK ANTHONY DIEHL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAGLE ROCK AVE STE 154
EAST HANOVER NJ
07936-3168
US

IV. Provider business mailing address

1501 ROUTE 10 APT 230
PARSIPPANY NJ
07054-4554
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-4772
  • Fax:
Mailing address:
  • Phone: 908-894-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MP00586300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00586300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: