MEDICARE: DR. EDWARD SKOBAC 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	207R00000X	Internal Medicine Physician	25MA04276700	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110144603	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285607671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD SKOBAC M.D.

Provider Business Mailing Address
First Line	:	42 E LAUREL RD STE 3100
Second Line	:
City	:	STRATFORD
State	:	NJ
Zip	:	08084-1354
Country	:	US
Telephone Number	:	856-566-7070
Fax Number	:	856-566-5079

Provider Business Practice Location Address
First Line	:	92 BRICK RD
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-2177
Country	:	US
Telephone Number	:	856-988-8778
Fax Number	:	856-988-8254

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	08/06/2021

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