Provider Demographics
NPI:1235283946
Name:FOBBEN, EDWARD SANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SANDER
Last Name:FOBBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 NOE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1507
Mailing Address - Country:US
Mailing Address - Phone:973-377-0793
Mailing Address - Fax:
Practice Address - Street 1:193 NOE AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1507
Practice Address - Country:US
Practice Address - Phone:973-377-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57172422085R0202X
NJ25MA052511002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27349Medicare UPIN