Healthcare Provider Details

I. General information

NPI: 1912089681
Provider Name (Legal Business Name): MARK WILLIAM ORNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MAIN ST
FARMINGDALE NJ
07727-1340
US

IV. Provider business mailing address

PO BOX 845
NEPTUNE NJ
07754-0845
US

V. Phone/Fax

Practice location:
  • Phone: 732-449-0914
  • Fax: 732-449-5437
Mailing address:
  • Phone: 732-449-0914
  • Fax: 732-449-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04828700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: