Healthcare Provider Details

I. General information

NPI: 1205501871
Provider Name (Legal Business Name): DLB MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 OTTAWA CT
TOMS RIVER NJ
08753-2962
US

IV. Provider business mailing address

1443 OTTAWA CT
TOMS RIVER NJ
08753-2962
US

V. Phone/Fax

Practice location:
  • Phone: 732-522-4868
  • Fax: 732-255-5659
Mailing address:
  • Phone: 732-522-4868
  • Fax: 732-255-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH BADER
Title or Position: OWNER
Credential: NP
Phone: 732-522-4868