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General NPI Number Information
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NPI Number | 1124235452
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Entity Type | Organization
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Legal Business Name | MARK MADIS,M.D. , LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 212 ROUTE 94 SUITE 1A
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City | VERNON
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State | NJ
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Zip | 07462-3328
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Country | US
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Telephone | 973-864-5033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1010
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City | VERNON
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State | NJ
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Zip | 07462-1010
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Country | US
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Telephone | 973-864-5033
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Fax | 973-209-1895
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Authorized Official
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Title or Position | OWNER
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Name | MARK STEVEN MADIS
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Credential | M.D.
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Telephone | 973-864-5033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 25MA04014100
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License Number State | NJ
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