Provider Demographics
NPI:1326145939
Name:TOBIAS, GEOFFREY WAYNE (MO)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:WAYNE
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:MO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-567-6770
Mailing Address - Fax:201-567-7966
Practice Address - Street 1:214 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-567-6770
Practice Address - Fax:201-567-7966
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36071207Y00000X
CAG39473207Y00000X
NY1353961207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU51545Medicaid
BS396OtherOXFORD
OK4604OtherHEALTH ACT
NJ3044505Medicaid
40890OtherAETNA
NJU51545Medicaid
OK4604OtherHEALTH ACT