Provider Demographics
NPI:1770967770
Name:MARK LEBENTHAL MD LLC
Entity type:Organization
Organization Name:MARK LEBENTHAL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEBENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-872-2253
Mailing Address - Street 1:1001 LAUREL TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2212
Mailing Address - Country:US
Mailing Address - Phone:908-872-2253
Mailing Address - Fax:732-469-8413
Practice Address - Street 1:1001 LAUREL TRL
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2212
Practice Address - Country:US
Practice Address - Phone:908-872-2253
Practice Address - Fax:732-469-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035336207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ846406Medicaid
NJE51889Medicare UPIN