Mark P Pandolfo, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00530300 Issued in NJ

Practice address

175 W Cohawkin Rd
Clarksboro, NJ 08020-1145

Phone

(856) 423-5559

NPI assigned

Feb 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 1997

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark Pandolfo, DC

  • Chiropractor
  • Clarksboro, NJ
  • NPI 1710952023
  NPD (past) Authorized official
• Prestige Rehabilitation Services LLC

  • Rehabilitation Chiropractor
  • Bala Cynwyd, PA
  • NPI 1386714673
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217203200000",
    "number": "1225003536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 W COHAWKIN RD",
            "city": "CLARKSBORO",
            "state": "NJ",
            "postal_code": "080201145",
            "telephone_number": "856-423-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 W COHAWKIN RD",
            "city": "CLARKSBORO",
            "state": "NJ",
            "postal_code": "080201145",
            "telephone_number": "856-423-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANDOLFO",
        "first_name": "MARK",
        "middle_name": "P",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2008-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00530300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7815107",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Brian Otoole
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• Emily Rose Salema, PSY.D.

• Chiropractor in Clarksboro, NJ
• Providers in Clarksboro, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.