Healthcare Provider Details

I. General information

NPI: 1790881944
Provider Name (Legal Business Name): MARTIN M FORSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 1800-A
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD STE 1800-A
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6843
  • Fax: 856-566-6419
Mailing address:
  • Phone: 856-566-6843
  • Fax: 856-566-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number25MA08104400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA08104400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: