Individual provider Active NPI

Mark Granick, MD

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Newark, NJ
National Provider Identifier
1235239328
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianTaxonomy code 2082S0099X
License
MA72027 Issued in NJ
Practice address
140 Bergen Street E
1620
Newark, NJ 19103
Phone
(973) 972-8092
NPI assigned
Sep 25, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X MA72027 NJ Primary
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X MA72027 NJ

Addresses

Primary practice location

140 Bergen Street E
1620
Newark, NJ 19103

Mailing address

6 Westmount Dr
Livingston, NJ 07039-4213
Phone (973) 972-8092

Other identifiers 1

IdentifierTypeStateIssuer
6762409MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051020000050 NJ Practitioner - Plastic and Reconstructive SurgeryPractitioner - Otolaryngology 0547286411 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: Otolaryngology
Education
Harvard Medical School, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

140 Bergen St
Newark, NJ 07103-2425
Phone (973) 972-9000

30 Bergen St
Newark, NJ 07107-3000
Phone (973) 972-0037

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA72027NJMDPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Associates of New Jersey Inc CurrentSince Apr 16, 2001 Accepting new patients
University Physician Associates of New Jersey Inc CurrentSince Apr 16, 2001 Accepting new patients
University Physician Associates of New Jersey Inc Past Accepting new patients
Suburban Plastic Surgeons PC Plastic Surgery Within the Head and Neck PastSince Jul 11, 2024 Accepting new patients

Locations

140 Bergen St
#E1620
Newark, NJ 07103
Phone (973) 972-5377

30 Bergen St
Newark, NJ 07107
Phone (973) 972-0037

30 Bergen St
Bldg 12
Newark, NJ 07107
Phone (973) 972-0037

30 Bergen St
Rm 1205
Newark, NJ 07107
Phone (973) 972-0037

90 Bergen St
Fl 7
Newark, NJ 07103
Phone (973) 972-5350

90 Bergen St
Fl Seventh
Newark, NJ 07103

Organizations & group practices 4

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1235239328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 WESTMOUNT DR",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394213",
            "telephone_number": "973-972-8092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 BERGEN STREET E",
            "address_2": "1620",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "19103",
            "telephone_number": "973-972-8092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANICK",
        "first_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "NJ",
            "license": "MA72027",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "NJ",
            "license": "MA72027",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6762409",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.