Healthcare Provider Details

I. General information

NPI: 1235283946
Provider Name (Legal Business Name): EDWARD SANDER FOBBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 NOE AVE
CHATHAM NJ
07928-1507
US

IV. Provider business mailing address

193 NOE AVE
CHATHAM NJ
07928-1507
US

V. Phone/Fax

Practice location:
  • Phone: 973-377-0793
  • Fax:
Mailing address:
  • Phone: 973-377-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5717242
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number76291
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05251100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: