Active NPI
Mark David Sherman, M.D.
- Surgery Physician
- Montvale, NJ
National Provider Identifier
1417095142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 25MA03595800
- Practice address
- 85 Chestnut Ridge Road Suite 111
Montvale, NJ 07645 - Phone
- (201) 444-1775
- Fax
- (201) 930-8509
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 25MA03595800 | NJ | Primary |
Addresses
Primary practice location
85 Chestnut Ridge Road Suite 111
Montvale, NJ 07645
Mailing address
85 Chestnut Ridge Road Suite 111
Montvale, NJ 07645
Phone (201) 444-1775
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222334181 | Other | FEDERAL TAX ID | |
| 3012107 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA03595800 | NJ | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427155200000",
"number": "1417095142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 CHESTNUT RIDGE ROAD SUITE 111",
"city": "MONTVALE",
"state": "NJ",
"postal_code": "07645",
"telephone_number": "201-444-1775",
"fax_number": "201-930-8509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 CHESTNUT RIDGE ROAD SUITE 111",
"city": "MONTVALE",
"state": "NJ",
"postal_code": "07645",
"telephone_number": "201-444-1775",
"fax_number": "201-930-8509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERMAN",
"first_name": "MARK",
"middle_name": "DAVID",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2015-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NJ",
"license": "25MA03595800",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "222334181",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3012107",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montvale, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.