Provider Demographics
NPI:1477583987
Name:MARDER, STEVEN JAY (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
Last Name:MARDER
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 1:1049 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-870-9700
Mailing Address - Fax:732-571-7873
Practice Address - Street 1:1049 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-870-9700
Practice Address - Fax:732-571-7873
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01368213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4742303Medicaid
NJMA591205Medicare ID - Type Unspecified
NJ4742303Medicaid