Provider Demographics
NPI:1013216183
Name:OBESITY TREATMENT CENTERS OF MORRIS COUNTY LLC
Entity Type:Organization
Organization Name:OBESITY TREATMENT CENTERS OF MORRIS COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-322-7977
Mailing Address - Street 1:200 S ORANGE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5817
Mailing Address - Country:US
Mailing Address - Phone:973-322-7977
Mailing Address - Fax:973-322-7979
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7977
Practice Address - Fax:973-322-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA061479261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty