Healthcare Provider Details

I. General information

NPI: 1922990050
Provider Name (Legal Business Name): LIFEBROOK SURGICAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MAIN ST
SPARTA NJ
07871-1903
US

IV. Provider business mailing address

61 MAIN ST
SPARTA NJ
07871-1903
US

V. Phone/Fax

Practice location:
  • Phone: 862-901-8701
  • Fax:
Mailing address:
  • Phone: 862-901-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH O CHIMA
Title or Position: PHYSICIAN
Credential:
Phone: 862-901-8701