MEDICARE: DR. MARK BRUCE SPAL D.P.M.,R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	25MD00213800	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480025935	OTHER	NJ	RAILRAOD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740284280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BRUCE SPAL D.P.M.,R.PH.

Provider Business Mailing Address
First Line	:	23 SPRINGHILL ROAD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-4324
Country	:	US
Telephone Number	:	973-895-4857
Fax Number	:	973-933-2030

Provider Business Practice Location Address
First Line	:	23 SPRINGHILL ROAD
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-4324
Country	:	US
Telephone Number	:	973-895-4857
Fax Number	:	973-933-2030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	03/04/2013

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