Provider Demographics
NPI:1366645467
Name:CENTRAL JERSEY BARIATRICS, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY BARIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-761-1740
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-761-1740
Mailing Address - Fax:732-761-8320
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-761-1740
Practice Address - Fax:732-761-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07345100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0014958Medicaid
NJ0014958Medicaid
NJA61512Medicare UPIN