Provider Demographics
NPI:1629147624
Name:POPLAWSKI, MARK EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:POPLAWSKI
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 1:555 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8044
Mailing Address - Country:US
Mailing Address - Phone:732-557-6336
Mailing Address - Fax:732-557-4103
Practice Address - Street 1:555 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8044
Practice Address - Country:US
Practice Address - Phone:732-557-6336
Practice Address - Fax:732-557-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00244300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0077658Medicaid
NJBP5759610OtherCONTROLLED DANGEROUS SUBS
NJBP9112436OtherCONTROLLED SUBSTANCE REGI
NJ004018Medicare ID - Type Unspecified
NJU68563Medicare UPIN