Provider Demographics
NPI:1932471059
Name:MONANE, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MONANE
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 1:5 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7911
Mailing Address - Country:US
Mailing Address - Phone:201-505-0670
Mailing Address - Fax:
Practice Address - Street 1:5 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-7911
Practice Address - Country:US
Practice Address - Phone:201-505-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-05
Last Update Date:2012-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine