Mark I Sisskin, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MA04343400 Issued in NJ

Practice address

3200 Sunset Ave
Suite 100
Ocean, NJ 07712-4556

Phone

(732) 774-4114

Fax

(732) 774-6869

NPI assigned

Feb 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Optum Medical Care of New Jersey PC

  • Pediatrics Physician
  • New Hyde Park, NY
  • NPI 1578665048

  Internal Medicine, NJ

  Medicare reassignment NPD
• Optum Medical Care of New Jersey PC

  • Durable Medical Equipment & Medical Supplies
  • Belleville, NJ
  • NPI 1255050902
  NPD

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1922071505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SUNSET AVE",
            "address_2": "SUITE 100",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077124556",
            "telephone_number": "732-774-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SUNSET AVE",
            "address_2": "SUITE 100",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077124556",
            "telephone_number": "732-774-4114",
            "fax_number": "732-774-6869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSKIN",
        "first_name": "MARK",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA04343400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "0K7979",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCARE",
            "identifier": "223360408-019",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1785702",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110172478",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P403608",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shore Growth and Wellness, LLC
• Shore Health Group, PC
• Shore Strength Physical Therapy and Sports Performance
• Shoreline Dental LLC
• Alyssa Siegel, MSN, RN, FNP-C
• Denise Siwinski, MD
• Laura Susan Sofield II, RN, APN-C
• Sondike Behavioral Connection LLC
• Christopher John Spagnuola, MD
• Michele Alice St. Marie, MSW

• Internal Medicine Physician in Ocean, NJ
• Providers in Ocean, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; 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.

Verify at the official NPI Registry.