Provider Demographics
NPI:1013916667
Name:NOTARI, MARC ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:NOTARI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:160 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1253
Mailing Address - Country:US
Mailing Address - Phone:201-939-9098
Mailing Address - Fax:201-939-5614
Practice Address - Street 1:160 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1253
Practice Address - Country:US
Practice Address - Phone:201-939-9098
Practice Address - Fax:201-939-5614
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1293213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ164545Medicare PIN