Provider Demographics
NPI:1598869919
Name:MARK L NIEMIERA MD PC
Entity Type:Organization
Organization Name:MARK L NIEMIERA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIEMIERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-442-1441
Mailing Address - Street 1:613 AMBOY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2577
Mailing Address - Country:US
Mailing Address - Phone:732-442-1441
Mailing Address - Fax:732-442-7684
Practice Address - Street 1:613 AMBOY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2577
Practice Address - Country:US
Practice Address - Phone:732-442-1441
Practice Address - Fax:732-442-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55677Medicare UPIN
NT455090Medicare ID - Type Unspecified