Healthcare Provider Details

I. General information

NPI: 1902805013
Provider Name (Legal Business Name): MITCHELL BOBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 N BROADWAY
PENNSVILLE NJ
08070-1550
US

IV. Provider business mailing address

181 N BROADWAY
PENNSVILLE NJ
08070-1550
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-9002
  • Fax: 856-678-4027
Mailing address:
  • Phone: 856-678-9002
  • Fax: 856-678-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB044548
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: