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General NPI Number Information
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NPI Number | 1710916432
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Entity Type | Organization
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Legal Business Name | R.C .LILLIE S.J. MARDER, D.P.M.'S
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 1049 BROADWAY
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764
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Country | US
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Telephone | 732-870-9700
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Fax | 732-571-7873
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Provider Business Mailing Address
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Address Line | 1049 BROADWAY
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764
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Country | US
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Telephone | 732-870-9700
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Fax | 732-571-7873
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. STEVEN J. MARDER
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Credential | D.P.M.
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Telephone | 732-870-9700
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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 | MD01368
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | MD01309
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License Number State | NJ
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