Healthcare Provider Details

I. General information

NPI: 1285626697
Provider Name (Legal Business Name): MARC JAY SCHLEMOVITZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CENTER GROVE RD
RANDOLPH NJ
07869-4453
US

IV. Provider business mailing address

121 CENTER GROVE RD
RANDOLPH NJ
07869-4453
US

V. Phone/Fax

Practice location:
  • Phone: 973-366-1016
  • Fax: 973-366-5925
Mailing address:
  • Phone: 973-366-1016
  • Fax: 973-366-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00111900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: