Provider Demographics
NPI:1437332749
Name:NEW JERSEY SPORTS MEDICINE AND PERFORMANCE CENTER LLC
Entity Type:Organization
Organization Name:NEW JERSEY SPORTS MEDICINE AND PERFORMANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SILBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-647-6464
Mailing Address - Street 1:689 VALLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1906
Mailing Address - Country:US
Mailing Address - Phone:908-647-6464
Mailing Address - Fax:908-647-6445
Practice Address - Street 1:689 VALLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:NJ
Practice Address - Zip Code:07933-1906
Practice Address - Country:US
Practice Address - Phone:908-647-6464
Practice Address - Fax:908-647-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07016200207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI17104Medicare UPIN
087959Medicare PIN