Provider Demographics
NPI:1770320764
Name:MERRIMAN, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MERRIMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N UNION AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-5100
Mailing Address - Country:US
Mailing Address - Phone:973-452-0010
Mailing Address - Fax:973-510-2027
Practice Address - Street 1:123 N UNION AVE STE 305
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-5100
Practice Address - Country:US
Practice Address - Phone:973-452-0010
Practice Address - Fax:973-510-2027
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0290800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health