Provider Demographics
NPI:1033454921
Name:LAYTON, MARK THEODORE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THEODORE
Last Name:LAYTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:551-999-6433
Mailing Address - Fax:551-500-2070
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:551-999-6433
Practice Address - Fax:551-500-2070
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00312700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical