Provider Demographics
NPI:1902856222
Name:DREIER, MARC MAX (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:MAX
Last Name:DREIER
Suffix:
Gender:M
Credentials:MD
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 1173
Mailing Address - Street 2:RIDGEWOOD
Mailing Address - City:07451
Mailing Address - State:NJ
Mailing Address - Zip Code:07451
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:223 N VAN DIEN AVENUE
Practice Address - Street 2:THE VALLEY HOSPITAL
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-2019
Practice Address - Fax:201-444-3604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05759000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6044701Medicaid
F14363Medicare UPIN
NJ118103Medicare ID - Type Unspecified