Provider Demographics
NPI:1942316831
Name:REINER, MARK J (DO FAOAO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:REINER
Suffix:
Gender:M
Credentials:DO FAOAO
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 8285
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-662-2400
Mailing Address - Fax:856-662-5525
Practice Address - Street 1:431 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-662-2400
Practice Address - Fax:856-662-5525
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB33385207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0381004Medicaid
NJ107327AYLMedicare PIN
E6105Medicare UPIN