Healthcare Provider Details

I. General information

NPI: 1043226012
Provider Name (Legal Business Name): MARK KAPLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax: 201-541-2188
Mailing address:
  • Phone: 201-894-3636
  • Fax: 201-541-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MP00072900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: