Provider Demographics
NPI:1205005782
Name:VICTOR SHAROBEEM MD LLC
Entity Type:Organization
Organization Name:VICTOR SHAROBEEM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAROBEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-322-2258
Mailing Address - Street 1:5 IVY WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-0000
Mailing Address - Country:US
Mailing Address - Phone:732-322-2258
Mailing Address - Fax:
Practice Address - Street 1:5 IVY WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-0000
Practice Address - Country:US
Practice Address - Phone:732-322-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09543Medicare PIN
NYWXQQR1Medicare PIN