Healthcare Provider Details

I. General information

NPI: 1770967770
Provider Name (Legal Business Name): MARK LEBENTHAL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAUREL TRL
MARTINSVILLE NJ
08836-2212
US

IV. Provider business mailing address

1001 LAUREL TRL
MARTINSVILLE NJ
08836-2212
US

V. Phone/Fax

Practice location:
  • Phone: 908-872-2253
  • Fax: 732-469-8413
Mailing address:
  • Phone: 908-872-2253
  • Fax: 732-469-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA035336
License Number StateNJ

VIII. Authorized Official

Name: DR. MARK J LEBENTHAL
Title or Position: OWNER
Credential: M.D.
Phone: 908-872-2253