Provider Demographics
NPI:1255501938
Name:DR. STEVEN MARDER, LLC
Entity Type:Organization
Organization Name:DR. STEVEN MARDER, LLC
Other - Org Name:DR MARDER FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-870-9700
Mailing Address - Street 1:1049 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1334
Mailing Address - Country:US
Mailing Address - Phone:732-870-9700
Mailing Address - Fax:732-571-7873
Practice Address - Street 1:1049 BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1334
Practice Address - Country:US
Practice Address - Phone:732-870-9700
Practice Address - Fax:732-571-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00136800213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6148740001Medicare NSC