Provider Demographics
NPI:1699731562
Name:MOKRZYCKI, MARK L (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:MOKRZYCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-651-0005
Mailing Address - Fax:732-651-0053
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:SUITE 219
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4098
Practice Address - Country:US
Practice Address - Phone:732-651-0005
Practice Address - Fax:732-651-0053
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65991207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00146016OtherRAILROAD MEDICARE
NJ7327404Medicaid
NJ7327404Medicaid
NJ959086B3LMedicare ID - Type Unspecified