Provider Demographics
NPI:1417165416
Name:CEREFICE, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CEREFICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1640 ROUTE 88 W
Mailing Address - Street 2:STE 202
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3068
Mailing Address - Country:US
Mailing Address - Phone:732-458-8300
Mailing Address - Fax:732-458-8529
Practice Address - Street 1:1640 ROUTE 88 W
Practice Address - Street 2:STE 202
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3068
Practice Address - Country:US
Practice Address - Phone:732-458-8300
Practice Address - Fax:732-458-8529
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08898900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ220178DG4Medicare PIN