Healthcare Provider Details

I. General information

NPI: 1134201841
Provider Name (Legal Business Name): MARK ADDONA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 CENTRAL AVE
WESTFIELD NJ
07090-2528
US

IV. Provider business mailing address

136 N UNION AVE
CRANFORD NJ
07016-2224
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-4448
  • Fax: 908-232-4502
Mailing address:
  • Phone: 908-276-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC003253
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: