Healthcare Provider Details

I. General information

NPI: 1376690032
Provider Name (Legal Business Name): MARK EDWIN HELBRAUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 811
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 811
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-525-1660
  • Fax: 201-525-1667
Mailing address:
  • Phone: 201-525-1660
  • Fax: 201-525-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35677
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: