Provider Demographics
NPI:1619929874
Name:SAPIENZA, MARK S (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:SAPIENZA
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 1:420 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4152
Mailing Address - Country:US
Mailing Address - Phone:201-569-7044
Mailing Address - Fax:201-569-1999
Practice Address - Street 1:420 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4152
Practice Address - Country:US
Practice Address - Phone:201-569-7044
Practice Address - Fax:201-569-1999
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07242400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3157169OtherAETNA US HEALTHCARE
NJP2664780OtherOXFORD HEALTH PLAN
NJ2K3068OtherHEALTHNET
NJ8875201Medicaid
NJ3V6321OtherEMPIRE HEALTH PLAN
NJ2499403OtherGHI
NJ2K3068OtherHEALTHNET
NJ3157169OtherAETNA US HEALTHCARE