Provider Demographics
NPI:1922071505
Name:SISSKIN, MARK I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
Last Name:SISSKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SUNSET AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4556
Mailing Address - Country:US
Mailing Address - Phone:732-774-4114
Mailing Address - Fax:
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4556
Practice Address - Country:US
Practice Address - Phone:732-774-4114
Practice Address - Fax:732-774-6869
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04343400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0K7979OtherHEALTHNET
NJ223360408-019OtherQUALCARE
NJ1785702Medicaid
NJ110172478OtherRAILROAD MEDICARE
NJP403608OtherOXFORD
NJ0K7979OtherHEALTHNET
NJ089297Medicare ID - Type Unspecified