Provider Demographics
NPI:1831161751
Name:RIEGER, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:RIEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:218 RIDGEDALE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2109
Mailing Address - Country:US
Mailing Address - Phone:973-538-7700
Mailing Address - Fax:973-538-9478
Practice Address - Street 1:218 RIDGEDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2109
Practice Address - Country:US
Practice Address - Phone:973-538-7700
Practice Address - Fax:973-538-9478
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53039207X00000X
CT64729207X00000X
NJ25MA05303900207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE22035Medicare ID - Type Unspecified
NJE22035Medicare UPIN