Provider Demographics
NPI:1356310528
Name:BIEBEL, MARK ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:BIEBEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FALCONS RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 N BEERS ST
Practice Address - Street 2:STE. 2C
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1518
Practice Address - Country:US
Practice Address - Phone:732-888-1717
Practice Address - Fax:732-888-2101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01539213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09761OtherEMPIRE BCBS
2K6415OtherHEALTH NET
10651921OtherCAQH
P403899OtherOXFORD ID
081577Medicare ID - Type UnspecifiedGROUP NUMBER
NJ518638Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
T45647Medicare UPIN