Provider Demographics
NPI:1821267220
Name:MARKRMENAQUALE,INC
Entity Type:Organization
Organization Name:MARKRMENAQUALE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENAQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-509-0898
Mailing Address - Street 1:310 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1604
Mailing Address - Country:US
Mailing Address - Phone:856-767-9100
Mailing Address - Fax:856-767-9571
Practice Address - Street 1:310 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1604
Practice Address - Country:US
Practice Address - Phone:856-767-9100
Practice Address - Fax:856-767-9571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARKRMENAQUALE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01443332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44881Medicare UPIN
NJ406051Medicare PIN
NJ5412750001Medicare NSC