Provider Demographics
NPI:1023373057
Name:SBK MD GROUP, LLC
Entity Type:Organization
Organization Name:SBK MD GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-461-5900
Mailing Address - Street 1:2083 CENTER AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2083 CENTER AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7400
Practice Address - Country:US
Practice Address - Phone:201-461-5900
Practice Address - Fax:201-461-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64078207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7879601Medicaid
NJ878740VYHMedicare PIN
NJ7879601Medicaid