Healthcare Provider Details

I. General information

NPI: 1386816056
Provider Name (Legal Business Name): SPORTS MEDICINE NEW JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 COUNTY ROAD SUITE 520
MARLBORO NJ
07746-1059
US

IV. Provider business mailing address

475 COUNTY ROAD SUITE 520
MARLBORO NJ
07746-1059
US

V. Phone/Fax

Practice location:
  • Phone: 732-946-2101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMB05602400
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVE WEINTRAUB
Title or Position: OWNER
Credential: DO
Phone: 732-946-2101