Provider Demographics
NPI:1053341438
Name:SOLOMON, MARK EPHRAIM (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EPHRAIM
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:218 RIDGEDALE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2109
Mailing Address - Country:US
Mailing Address - Phone:973-538-7700
Mailing Address - Fax:973-538-9478
Practice Address - Street 1:218 RIDGEDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2109
Practice Address - Country:US
Practice Address - Phone:973-538-7700
Practice Address - Fax:973-538-9478
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00268100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08132700OtherCDS
NJ25MD00268100OtherSTATE LICENSE
NJBS7727944OtherDEA
NJ25MD00268100OtherSTATE LICENSE