Provider Demographics
NPI:1023110749
Name:KOBYLARZ, FRED A (MD, MPH)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:A
Last Name:KOBYLARZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:18 CENTRE DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1501
Practice Address - Country:US
Practice Address - Phone:609-655-5178
Practice Address - Fax:609-655-5284
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0628900207Q00000X, 207QG0300X
IA29924207QG0300X
FLME90906207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6933904Medicaid
G53098Medicare UPIN
NJ951597Medicare PIN
NJ6933904Medicaid
NJ951597DFFMedicare PIN