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General NPI Number Information
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NPI Number | 1154366466
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Entity Type | Organization
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Legal Business Name | MITCHELL BOBER, D.O.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 250 S BROADWAY
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City | PENNSVILLE
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State | NJ
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Zip | 08070-2700
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Country | US
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Telephone | 856-678-9002
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Fax | 856-678-4027
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Provider Business Mailing Address
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Address Line | 250 S BROADWAY
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City | PENNSVILLE
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State | NJ
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Zip | 08070-2700
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Country | US
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Telephone | 856-678-9002
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Fax | 856-678-4027
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MITCHELL BOBER
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Credential | D.O.
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Telephone | 856-678-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB04454800
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License Number State | NJ
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