Basic Information
| Provider Information | |||||||||
| NPI: | 1639151129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHABER | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 RARITAN COMMONS RTE 31 NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087825100 | ||||||||
| FaxNumber: | 9087820290 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 RARITAN COMMONS RTE 31 NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087825100 | ||||||||
| FaxNumber: | 9087820290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA06375300 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 174400000X | 25MA06375300 | NJ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 25MA06375300 | 01 | NJ | MEDICAL LICENSE | OTHER | 60040253 | 01 | NJ | HORIZON NJ DIRECT | OTHER | 877761 | 01 | FOCUS | OTHER | 1504841 | 01 | QUALCARE | OTHER | 1K5727 | 01 | HEALTHNET | OTHER | 0521926000 | 01 | PA | INDEPENDECE BLUE CROSS | OTHER | P2198796 | 01 | OXFORD | OTHER | 2378887 | 01 | AETNA | OTHER | 2922868009 | 01 | CIGNA | OTHER | 010063753NJ01 | 01 | NJ | ANTHEM | OTHER | 1807148 | 01 | UNITED HEALTHCARE | OTHER | 2593373 | 01 | GHI | OTHER | 533L01 | 01 | NY | EMPIRE | OTHER | 7767404 | 05 | NJ | MEDICAID |