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General NPI Number Information
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NPI Number | 1366645467
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY BARIATRICS, LLC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 901 W MAIN ST SUITE 104
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 732-761-1740
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Fax | 732-761-8320
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Provider Business Mailing Address
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Address Line | 901 W MAIN ST SUITE 104
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 732-761-1740
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Fax | 732-761-8320
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | ANTONIO G LAZARUS
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Credential |
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Telephone | 732-761-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA07345100
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License Number State | NJ
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