Provider Demographics
NPI:1295115277
Name:MAYORGA, MABEL AMARYLLIS (MD)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:AMARYLLIS
Last Name:MAYORGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:902 OAK TREE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5139
Mailing Address - Country:US
Mailing Address - Phone:908-756-0040
Mailing Address - Fax:908-756-1793
Practice Address - Street 1:902 OAK TREE AVE STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5139
Practice Address - Country:US
Practice Address - Phone:908-756-0040
Practice Address - Fax:908-756-1793
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10310500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism