Provider Demographics
NPI:1013109669
Name:MARIO J. ARENA, M.D., P.C.
Entity Type:Organization
Organization Name:MARIO J. ARENA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-310-0002
Mailing Address - Street 1:17 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1299
Mailing Address - Country:US
Mailing Address - Phone:856-310-0002
Mailing Address - Fax:856-310-0003
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 3
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1299
Practice Address - Country:US
Practice Address - Phone:856-310-0002
Practice Address - Fax:856-310-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024494E207X00000X
NJMA52390207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077129OtherMEDICARE ID
PA163142OtherMEDICARE ID
NJ077129OtherMEDICARE ID
PA163142OtherMEDICARE ID
PA163142Medicare PIN