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General NPI Number Information
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NPI Number | 1558418004
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Entity Type | Organization
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Legal Business Name | NON-INVASIVE LAB AT ST BARNABAS
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 94 OLD SHORT HILLS RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5672
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Country | US
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Telephone | 973-731-9442
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Fax | 973-731-8755
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Provider Business Mailing Address
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Address Line | 94 OLD SHORT HILLS RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5672
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Country | US
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Telephone | 973-731-9442
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Fax | 973-731-8755
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. DONALD JAMES BROCK
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Credential | M.D.
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Telephone | 973-731-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA25746
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License Number State | NJ
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