Healthcare Provider Details

I. General information

NPI: 1639151129
Provider Name (Legal Business Name): MARC L SHABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RARITAN COMMONS RTE 31 NORTH SUITE 105
FLEMINGTON NJ
08822-1154
US

IV. Provider business mailing address

200 RARITAN COMMONS RTE 31 NORTH SUITE 105
FLEMINGTON NJ
08822-1154
US

V. Phone/Fax

Practice location:
  • Phone: 908-782-5100
  • Fax: 908-782-0290
Mailing address:
  • Phone: 908-782-5100
  • Fax: 908-782-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06375300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06375300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: