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General NPI Number Information
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NPI Number | 1932378346
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Entity Type | Organization
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Legal Business Name | MARKRMENAQUALE,INC
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 4010 W BRIGANTINE AVE
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City | BRIGANTINE
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State | NJ
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Zip | 08203-3326
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Country | US
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Telephone | 609-264-1160
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Fax | 609-264-7744
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Provider Business Mailing Address
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Address Line | 4010 W. BRIGANTINE AVE.
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City | BRIGANTINE
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State | NJ
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Zip | 08203
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Country | US
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Telephone | 609-264-1160
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Fax | 609-264-7744
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. MARK R MENAQUALE
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Credential | DPM
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Telephone | 609-509-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MD01443
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License Number State | NJ
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