Basic Information
| Provider Information | |||||||||
| NPI: | 1104062256 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DARIANO | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 LONGWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SICKLERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080814028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566295901 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 220 CHAPEL AVE WEST | ||||||||
| Address2: | KHS | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564886832 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2008 | ||||||||
| LastUpdateDate: | 09/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NO10015200 | NJ | Y | Nursing Service Providers | Registered Nurse |
No ID Information.