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General NPI Number Information
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NPI Number | 1013216183
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Entity Type | Organization
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Legal Business Name | OBESITY TREATMENT CENTERS OF MORRIS COUNTY LLC
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 200 S ORANGE AVE SUITE 203
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5817
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Country | US
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Telephone | 973-322-7977
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Fax | 973-322-7979
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Provider Business Mailing Address
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Address Line | 200 S ORANGE AVE SUITE 203
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5817
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Country | US
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Telephone | 973-322-7977
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Fax | 973-322-7979
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | MICHAEL J NUSBAUM
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Credential | M.D.
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Telephone | 973-322-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA061479
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License Number State | NJ
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