Healthcare Provider Details

I. General information

NPI: 1699748848
Provider Name (Legal Business Name): MARIA G KATSOULIS-EMNACE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 70 STE 1C
BRICK NJ
08723-4022
US

IV. Provider business mailing address

495 JACK MARTIN BLVD
BRICK NJ
08724-7778
US

V. Phone/Fax

Practice location:
  • Phone: 732-279-6537
  • Fax: 732-458-6356
Mailing address:
  • Phone: 732-458-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06779100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: