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General NPI Number Information
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NPI Number | 1548735145
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Entity Type | Organization
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Legal Business Name | PREMIER BARIATRIC NEW JERSEY PC
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 1680 ROUTE 23
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City | WAYNE
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State | NJ
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Zip | 07470-7501
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Country | US
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Telephone | 516-616-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 125 MINEOLA AVE STE 200
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2042
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAWN GARBER
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Credential |
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Telephone | 516-616-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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