Provider Demographics
NPI:1942444385
Name:PAUL LOEB, D.O., P.A.
Entity Type:Organization
Organization Name:PAUL LOEB, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-586-5380
Mailing Address - Street 1:1301 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3826
Mailing Address - Country:US
Mailing Address - Phone:609-586-5380
Mailing Address - Fax:609-586-8853
Practice Address - Street 1:1301 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3826
Practice Address - Country:US
Practice Address - Phone:609-586-5380
Practice Address - Fax:609-586-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB51639207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE67428Medicare UPIN