Provider Demographics
NPI:1699702019
Name:SCHOENFELD, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:SCHOENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MORRIS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1426
Mailing Address - Country:US
Mailing Address - Phone:973-232-5391
Mailing Address - Fax:973-232-5392
Practice Address - Street 1:55 MORRIS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1426
Practice Address - Country:US
Practice Address - Phone:973-232-5391
Practice Address - Fax:973-232-5392
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04106200207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18798Medicare UPIN