Provider Demographics
NPI:1598815409
Name:NIERENBERG, MARK D (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:NIERENBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 ROUTE 22
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3476
Mailing Address - Country:US
Mailing Address - Phone:908-595-9360
Mailing Address - Fax:908-253-0721
Practice Address - Street 1:3322 ROUTE 22
Practice Address - Street 2:SUITE 1101
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-595-9360
Practice Address - Fax:908-253-0721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00470600111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU39598Medicare UPIN
NJNI004812Medicare ID - Type Unspecified