Healthcare Provider Details

I. General information

NPI: 1154309672
Provider Name (Legal Business Name): MICHAEL MARKOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 HIGHWAY 35
RED BANK NJ
07701-5037
US

IV. Provider business mailing address

529 HIGHWAY 35
RED BANK NJ
07701-5037
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-9800
  • Fax: 732-758-6367
Mailing address:
  • Phone: 732-741-9800
  • Fax: 732-758-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA049001100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: