Healthcare Provider Details

I. General information

NPI: 1457309619
Provider Name (Legal Business Name): MARK RANDOLPH RISER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

IV. Provider business mailing address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

V. Phone/Fax

Practice location:
  • Phone: 973-740-0607
  • Fax:
Mailing address:
  • Phone: 973-740-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9900332
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number268189-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9900332
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number268189-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13867
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13867
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: