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General NPI Number Information
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NPI Number | 1003059536
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Entity Type | Organization
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Legal Business Name | MARK LISTER, M.D., PA
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 495 N 13TH ST
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City | NEWARK
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State | NJ
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Zip | 07107-1317
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Country | US
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Telephone | 973-844-1340
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Fax | 973-450-5964
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Provider Business Mailing Address
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Address Line | 495 N 13TH ST
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City | NEWARK
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State | NJ
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Zip | 07107-1317
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Country | US
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Telephone | 973-844-1340
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Fax | 973-450-5964
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ANTHONY LISTER
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Credential | M.D.
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Telephone | 973-844-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA04176200
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License Number State | NJ
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