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General NPI Number Information
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NPI Number | 1518260512
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Entity Type | Organization
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Legal Business Name | MARK LICHTENBERG, MD
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 55 MORRIS AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1426
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Country | US
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Telephone | 201-926-6151
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Fax | 509-463-9780
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Provider Business Mailing Address
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Address Line | 55 MORRIS AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1426
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Country | US
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Telephone | 201-926-6151
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Fax | 509-463-9780
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JASON P CERVERA
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Credential |
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Telephone | 201-926-6151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number |
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License Number State |
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