Provider Demographics
NPI:1801965090
Name:TWARDZIK, MARK J (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:TWARDZIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5733
Mailing Address - Country:US
Mailing Address - Phone:609-344-3900
Mailing Address - Fax:609-344-8512
Practice Address - Street 1:4503 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-5733
Practice Address - Country:US
Practice Address - Phone:609-344-3900
Practice Address - Fax:609-344-8512
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMDO1233213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ583293TVOtherMEDICARE PTAN
NJ2285606Medicaid
NJTW583293Medicare ID - Type Unspecified
NJ2285606Medicaid