MEDICARE: MARK LEBENTHAL MD LLC

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	207RC0000X	Cardiovascular Disease Physician	MA035336	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1770967770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK LEBENTHAL MD LLC

Provider Business Mailing Address
First Line	:	1001 LAUREL TRL
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2212
Country	:	US
Telephone Number	:	908-872-2253
Fax Number	:	732-469-8413

Provider Business Practice Location Address
First Line	:	1001 LAUREL TRL
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2212
Country	:	US
Telephone Number	:	908-872-2253
Fax Number	:	732-469-8413

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK J LEBENTHAL
Credential	:	M.D.
Telephone Number	:	908-872-2253

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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