MEDICARE: BRANCH MEDICAL CLINIC EARLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1477750990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANCH MEDICAL CLINIC EARLE

Provider Business Mailing Address
First Line	:	201 STATE ROUTE 34 S
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 STATE ROUTE 34 S
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1902
Country	:	US
Telephone Number	:	732-866-2300
Fax Number	:

Authorized Official
Title or Position	:	NAVY MEDICINE UBO PROGRAM MANAGER
Name	:	MR. WILLIAM MICHAEL CONDON
Credential	:
Telephone Number	:	240-401-3643

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	12/19/2017

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Directions to “BRANCH MEDICAL CLINIC EARLE ” Practice Location

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