Provider Demographics
NPI:1518006584
Name:ENDE, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ENDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ROUTE 9
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-3625
Mailing Address - Country:US
Mailing Address - Phone:609-756-0000
Mailing Address - Fax:609-488-1613
Practice Address - Street 1:1228 ROUTE 37 W
Practice Address - Street 2:SUITE 6
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4811
Practice Address - Country:US
Practice Address - Phone:732-244-2700
Practice Address - Fax:732-244-7666
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB45244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0676209Medicaid
NJE N 445304OtherMEDICARE
NJ0676209Medicaid