1265967863 NPI number — MOBILE MEDICAL SERVICES OF NEW JERSEY, PC

Table of content: DR. MARK T MASON PHARM.D, (NPI 1497026975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265967863 NPI number — MOBILE MEDICAL SERVICES OF NEW JERSEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE MEDICAL SERVICES OF NEW JERSEY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1265967863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 MARCUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-622-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 ROUTE 17
Provider Second Line Business Practice Location Address:
12TH FLOOR
Provider Business Practice Location Address City Name:
RUTHERFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07070-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-372-1689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PELLMAN
Authorized Official First Name:
ELLIOT
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
516-622-6000

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  25MA08404500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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