Provider Demographics
NPI:1104897016
Name:NAGEL, MARK E (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:NAGEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BAIRD DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-2246
Mailing Address - Country:US
Mailing Address - Phone:908-359-6939
Mailing Address - Fax:
Practice Address - Street 1:476 AMWELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-3400
Practice Address - Country:US
Practice Address - Phone:908-281-6515
Practice Address - Fax:908-281-6269
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA03134208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ417168TXQMedicare ID - Type Unspecified