Provider Demographics
NPI:1922067180
Name:WERTENTEIL, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:WERTENTEIL
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 1:20-20 FAIR LAWN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2319
Mailing Address - Country:US
Mailing Address - Phone:201-703-0202
Mailing Address - Fax:201-703-1231
Practice Address - Street 1:20-20 FAIR LAWN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2319
Practice Address - Country:US
Practice Address - Phone:201-703-0202
Practice Address - Fax:201-703-1231
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ64782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P626640OtherOXFORD
1750922OtherUNITEDHEALTHCARE
NJ7372604Medicaid
5240557OtherAETNA
0464052000OtherAMERIHEALTH
1750922OtherUNITEDHEALTHCARE
NJ032887Medicare ID - Type UnspecifiedMY GROUP'S MEDICARE NUMBE
P626640OtherOXFORD
NJ7372604Medicaid