Provider Demographics
NPI:1962856583
Name:FILLARI, MARK (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FILLARI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CENTRE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1501
Mailing Address - Country:US
Mailing Address - Phone:609-860-9311
Mailing Address - Fax:609-860-9311
Practice Address - Street 1:18 CENTRE DR STE 203
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1501
Practice Address - Country:US
Practice Address - Phone:609-860-9111
Practice Address - Fax:609-860-9311
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00344900213E00000X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program