| Organization Name: | GARDEN STATE BARIATRICS & WELLNESS CENTER,LLC |
| NPI Number: | 1104008374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL L BILOF (OWNER) |
| Mailing Address: | 225 Millburn Ave Suite 204 Millburn |
| State: | NJ US |
| Postal Code: | 070411737 |
| Phone Number: | 9732181990 |
| Fax Number: | 9736291274 |
| NPI Enumeration Date: | 11/29/2007 |
| NPI Last Update Date: | 02/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | NJ25MA05641900 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |