Provider Demographics
NPI:1770503617
Name:OLESNICKY, MARK THEODORE II (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:THEODORE
Last Name:OLESNICKY
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:135 COLUMBIA TRNPK
Mailing Address - Street 2:STE 203
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-822-5000
Mailing Address - Fax:973-822-3321
Practice Address - Street 1:135 COLUMBIA TRNPK
Practice Address - Street 2:STE 203
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-822-3693
Practice Address - Fax:973-822-3321
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-05-26
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Provider Licenses
StateLicense IDTaxonomies
NJ27783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1642707Medicaid
NJ222044453OtherHORIZON
NJD08492OtherOXFORD
NJ46931OtherAETNA
NJ46931OtherAETNA
C55455Medicare UPIN