Basic Information
| Provider Information | |||||||||
| NPI: | 1356421812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EINSTEIN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 S ORANGE AVE | ||||||||
| Address2: | RUTGERS NEW JERSEY MEDICAL SCHOOL, MSB E-506 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725266 | ||||||||
| FaxNumber: | 9739724574 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 S ORANGE AVE | ||||||||
| Address2: | RUTGERS NEW JERSEY MEDICAL SCHOOL, MSB E-506 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725266 | ||||||||
| FaxNumber: | 9739724574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 25MA06535400 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VX0000X | 25MA06535400 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207VX0201X | 25MA06535400 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207VG0400X | 214124 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7822006 | 05 | NJ | MEDICAID |