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General NPI Number Information
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NPI Number | 1356342992
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Entity Type | Individual
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Provider Name | MARC MITNICK DPM
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Gender | Male
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 360 SPRINGFIELD AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-4608
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Country | US
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Telephone | 908-522-0761
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Fax | 908-926-2111
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Provider Business Mailing Address
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Address Line | 1 STUART CT
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City | PINE BROOK
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State | NJ
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Zip | 07058-9646
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Country | US
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Telephone | 973-882-9736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00109000
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License Number State | NJ
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