MEDICARE: DR. EDWARD SANDER FOBBEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	5717242	UT
2	2085R0202X	Diagnostic Radiology Physician	76291	TN
3	2085R0202X	Diagnostic Radiology Physician	25MA05251100	NJ

General Provider Information

NPI Number	:	1235283946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD SANDER FOBBEN M.D.

Provider Business Mailing Address
First Line	:	193 NOE AVE
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-1507
Country	:	US
Telephone Number	:	973-377-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 NOE AVE
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-1507
Country	:	US
Telephone Number	:	973-377-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/05/2025

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