Provider Demographics
NPI:1063463016
Name:MARKBREITER, LANCE A (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:A
Last Name:MARKBREITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4917
Mailing Address - Country:US
Mailing Address - Phone:732-530-1515
Mailing Address - Fax:732-345-6497
Practice Address - Street 1:35 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4917
Practice Address - Country:US
Practice Address - Phone:732-530-1515
Practice Address - Fax:732-345-6497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60645207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6170706Medicaid
NJ6170706Medicaid
NJF80496Medicare UPIN