MEDICARE: DR. MARK J TWARDZIK DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	MDO1233	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	583293TV	OTHER	NJ	MEDICARE PTAN

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	:	1801965090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J TWARDZIK DPM

Provider Business Mailing Address
First Line	:	4503 ATLANTIC AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-5733
Country	:	US
Telephone Number	:	609-344-3900
Fax Number	:	609-344-8512

Provider Business Practice Location Address
First Line	:	4503 ATLANTIC AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-5733
Country	:	US
Telephone Number	:	609-344-3900
Fax Number	:	609-344-8512

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	06/25/2013

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