Provider Demographics
NPI:1891813168
Name:MARRON, DAVID THOMAS
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:MARRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-0316
Mailing Address - Country:US
Mailing Address - Phone:732-660-1115
Mailing Address - Fax:732-660-1152
Practice Address - Street 1:179 AVENUE AT THE CMN
Practice Address - Street 2:STRE 5
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:732-542-1272
Practice Address - Fax:732-542-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMD840402OtherGHI ID
NJ222535373OtherGENERAL INSURANCE ID
NJP767316OtherAETNA ID
NJT45605Medicare UPIN
NJ222535373OtherGENERAL INSURANCE ID