Provider Demographics
NPI:1982788691
Name:PREMINGER, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:PREMINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:223 N VAN DIEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2726
Mailing Address - Country:US
Mailing Address - Phone:201-432-7837
Mailing Address - Fax:201-432-7830
Practice Address - Street 1:223 N VAN DIEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2726
Practice Address - Country:US
Practice Address - Phone:201-432-7837
Practice Address - Fax:201-432-7830
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY168818207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100066707Medicare PIN
NJ696454YHA7Medicare PIN
NJE17606Medicare UPIN
NJE17606Medicare UPIN