Provider Demographics
NPI:1346240785
Name:LEBENTHAL, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LEBENTHAL
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 1:1001 LAUREL TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2212
Mailing Address - Country:US
Mailing Address - Phone:908-872-2253
Mailing Address - Fax:732-469-8413
Practice Address - Street 1:1001 LAUREL TRL
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2212
Practice Address - Country:US
Practice Address - Phone:908-872-2253
Practice Address - Fax:732-469-8413
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035336207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ846406Medicaid
NJ846406Medicaid
NJ846406Medicaid