Healthcare Provider Details

I. General information

NPI: 1104062256
Provider Name (Legal Business Name): MR. MARK J DARIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W JIMMIE LEEDS RD
POMONA NJ
08240-9102
US

IV. Provider business mailing address

90 LONGWOOD DR
SICKLERVILLE NJ
08081-4028
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-1000
  • Fax:
Mailing address:
  • Phone: 856-629-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00198200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: