Provider Demographics
NPI:1225291123
Name:MANN, MARK JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JONATHAN
Last Name:MANN
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 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:225 MILLBURN AVE STE 304
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1712
Practice Address - Country:US
Practice Address - Phone:973-218-9400
Practice Address - Fax:973-218-9420
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451932208800000X
NJ25MA09795800208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0421481Medicaid
PA102951397 0001Medicaid
PA360985Medicare PIN