Provider Demographics
NPI:1538261250
Name:DRZALA, MARK R (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:DRZALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:R
Other - Last Name:DRZALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07902-0370
Mailing Address - Country:US
Mailing Address - Phone:908-608-9610
Mailing Address - Fax:908-608-9611
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE 305
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:908-608-9610
Practice Address - Fax:908-608-9611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058233207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG74417Medicare UPIN
NJ011775Medicare ID - Type Unspecified