Provider Demographics
NPI:1629841820
Name:PARISEN, MARK ANDREW (PTA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:PARISEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2220
Mailing Address - Country:US
Mailing Address - Phone:732-500-3579
Mailing Address - Fax:
Practice Address - Street 1:220 CENTENNIAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3940
Practice Address - Country:US
Practice Address - Phone:732-980-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00386800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant