Healthcare Provider Details

I. General information

NPI: 1104806553
Provider Name (Legal Business Name): JOHN MARK ENGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CORNWALL CT
EAST BRUNSWICK NJ
08816-3331
US

IV. Provider business mailing address

4 CORNWALL CT
EAST BRUNSWICK NJ
08816-3331
US

V. Phone/Fax

Practice location:
  • Phone: 732-613-9191
  • Fax: 732-613-1139
Mailing address:
  • Phone: 732-613-9191
  • Fax: 732-613-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA05771200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number25MA05771200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: