Provider Demographics
NPI:1558456822
Name:KRELL, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:ONE SPRINGFIELD AVE.
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4055
Mailing Address - Country:US
Mailing Address - Phone:908-273-1999
Mailing Address - Fax:908-273-1332
Practice Address - Street 1:ONE SPRINGFIELD AVE.
Practice Address - Street 2:SUITE 2A
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-273-1999
Practice Address - Fax:908-273-1332
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04647200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0273007Medicaid
NJ443724R5QMedicare ID - Type Unspecified
NJ0273007Medicaid