Provider Demographics
NPI:1043432925
Name:BARTISS, MARK JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:BARTISS
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 1:24 NAUTILUS DR STE 5
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2490
Mailing Address - Country:US
Mailing Address - Phone:609-978-9002
Mailing Address - Fax:
Practice Address - Street 1:24 NAUTILUS DR STE 5
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2490
Practice Address - Country:US
Practice Address - Phone:609-978-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55570173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0273902Medicaid
NJ642802MC5Medicare ID - Type Unspecified
NJ0273902Medicaid