Provider Demographics
NPI:1629124722
Name:SOBEL, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SOBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 FIRST AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-6354
Mailing Address - Country:US
Mailing Address - Phone:732-291-4085
Mailing Address - Fax:732-291-4086
Practice Address - Street 1:25 FIRST AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-6354
Practice Address - Country:US
Practice Address - Phone:732-291-4085
Practice Address - Fax:732-291-4086
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06303500207XX0004X
NY177451-1207XX0004X, 174400000X
FLME91602207XX0004X
OH35064874S174400000X
NJMA063035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF24058Medicare UPIN