Provider Demographics
NPI:1992894091
Name:NORTHERN VALLEY OBA, PA
Entity type:Organization
Organization Name:NORTHERN VALLEY OBA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-623-2000
Mailing Address - Street 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:561-623-2000
Mailing Address - Fax:865-291-3612
Practice Address - Street 1:375 ENGLE ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1823
Practice Address - Country:US
Practice Address - Phone:201-871-6073
Practice Address - Fax:201-871-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDC9942OtherRAILROAD MEDICARE
NJ0078891Medicaid
NJ088478Medicare ID - Type Unspecified