Provider Demographics
NPI:1376950113
Name:SHEARER, MARK I (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SHEARER
Suffix:I
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 1:160 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1275
Mailing Address - Country:US
Mailing Address - Phone:201-939-9098
Mailing Address - Fax:
Practice Address - Street 1:160 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1275
Practice Address - Country:US
Practice Address - Phone:201-939-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP93821213ES0103X
NJ25MD00338000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY150532221Medicare UPIN
NY150532221Medicare Oscar/Certification
NY150532221Medicare PIN
NY150532221Medicare PIN