1780788109 NPI number — MARK LEE NIEMIERA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780788109 NPI number — MARK LEE NIEMIERA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NIEMIERA

Provider First Name:

MARK

Provider Middle Name:

LEE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1780788109

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/19/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

613 AMBOY AVE

Provider Second Line Business Mailing Address:

SUITE 104

Provider Business Mailing Address City Name:

PERTH AMBOY

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08861-2577

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

732-442-1441

Provider Business Mailing Address Fax Number:

732-442-7684

Provider First Line Business Practice Location Address:

613 AMBOY AVE

Provider Second Line Business Practice Location Address:

SUITE 104

Provider Business Practice Location Address City Name:

PERTH AMBOY

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08861-2577

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

732-442-1441

Provider Business Practice Location Address Fax Number:

732-442-7684

Provider Enumeration Date:

09/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  25MAO4370700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: LS183 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 0K5093 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 1905902-01 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 77K03 . This is a "EMPIRE HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 241137 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 4094350 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0105202000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 10145 . This is a "UNIVERSITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 0997948 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 060022093 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 13611 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 455090 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 28022 . This is a "LOCAL 825 FUND" identifier . This identifiers is of the category "OTHER".
• Identifier: 37769 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 68713 . This is a "GHI" identifier . This identifiers is of the category "OTHER".