Provider Demographics
NPI:1871828731
Name:GARDEN STATE BARIATRICS & WELLNESS CENTER
Entity Type:Organization
Organization Name:GARDEN STATE BARIATRICS & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BILOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-218-1990
Mailing Address - Street 1:355 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1292
Mailing Address - Country:US
Mailing Address - Phone:973-218-1990
Mailing Address - Fax:973-218-1993
Practice Address - Street 1:355 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1292
Practice Address - Country:US
Practice Address - Phone:973-218-1990
Practice Address - Fax:973-218-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05641900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119260Medicare PIN