Active NPI
Mark J. Pesner, PH.D.
- Psychologist
- Fairfield, NJ
National Provider Identifier
1861555336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2562
- Practice address
- 271 US Highway 46
Suite G101
Fairfield, NJ 07004-2440 - Phone
- (973) 276-9040
- Fax
- (973) 276-9062
- NPI assigned
- Dec 18, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2562 | NJ | Primary |
Addresses
Primary practice location
271 US Highway 46
Suite G101
Fairfield, NJ 07004-2440
Mailing address
271 US Highway 46
Suite G101
Fairfield, NJ 07004-2440
Phone (973) 276-9040
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050421000816 | NJ | Practitioner - Clinical Psychologist | 8123066982 | Practice locations: Cedar Grove, NJ |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2562 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861555336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "271 US HIGHWAY 46",
"address_2": "SUITE G101",
"city": "FAIRFIELD",
"state": "NJ",
"postal_code": "070042440",
"telephone_number": "973-276-9040",
"fax_number": "973-276-9062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "271 US HIGHWAY 46",
"address_2": "SUITE G101",
"city": "FAIRFIELD",
"state": "NJ",
"postal_code": "070042440",
"telephone_number": "973-276-9040",
"fax_number": "973-276-9062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESNER",
"first_name": "MARK",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "2562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, NJ
- Patterson Caring Hearts LLC (Compassionate Helpers)
- Leslie Pearson, CNIM
- Perfect Ten Physical Therapy
- Branden Perkins
- Theodore Perl, M.D.
- Alexandra Maria Petrescu
- Physion, Inc.
- Joseph Plasner, PH.D.
- Katherine Therese Posillico
- Professional Health Care PT LLC Dba Healthcare Directives (Healthcare Directives)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.