Healthcare Provider Details

I. General information

NPI: 1437332749
Provider Name (Legal Business Name): NEW JERSEY SPORTS MEDICINE AND PERFORMANCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 VALLEY RD STE 104
GILLETTE NJ
07933-1906
US

IV. Provider business mailing address

689 VALLEY RD STE 104
GILLETTE NJ
07933-1906
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-6464
  • Fax: 908-647-6445
Mailing address:
  • Phone: 908-647-6464
  • Fax: 908-647-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMA07016200
License Number StateNJ

VIII. Authorized Official

Name: DR. MARC SILBERMAN
Title or Position: OWNER
Credential: M.D.
Phone: 908-647-6464