Provider Demographics
NPI:1285812388
Name:DR.MARC A. NOTARI DPM L.L.C.
Entity type:Organization
Organization Name:DR.MARC A. NOTARI DPM L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOTARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-939-9098
Mailing Address - Street 1:160 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1253
Mailing Address - Country:US
Mailing Address - Phone:201-939-9098
Mailing Address - Fax:201-939-5614
Practice Address - Street 1:160 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1253
Practice Address - Country:US
Practice Address - Phone:201-939-9098
Practice Address - Fax:201-939-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5374850001Medicare NSC