Provider Demographics
NPI:1417374174
Name:MURRAY, MARK A I (HIS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:MURRAY
Suffix:I
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 HAMILTON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1057
Mailing Address - Country:US
Mailing Address - Phone:609-788-8925
Mailing Address - Fax:
Practice Address - Street 1:505 HAMILTON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1057
Practice Address - Country:US
Practice Address - Phone:609-788-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1135237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0234885Medicaid