Provider Demographics
NPI:1194063677
Name:NJ BARIATRIC INSTITUTE LLC
Entity type:Organization
Organization Name:NJ BARIATRIC INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERTHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-904-3096
Mailing Address - Street 1:299 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6166
Mailing Address - Country:US
Mailing Address - Phone:860-904-3096
Mailing Address - Fax:860-288-8671
Practice Address - Street 1:299 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6166
Practice Address - Country:US
Practice Address - Phone:860-904-3096
Practice Address - Fax:860-288-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05719100207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty