Healthcare Provider Details

I. General information

NPI: 1417018292
Provider Name (Legal Business Name): MONMOUTH MEDICAL ASSOCIATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 PARKER ROAD
EATONTOWN NJ
07724
US

IV. Provider business mailing address

450 SHREWSBURY PLAZA SUITE 291
SHREWSBURY NJ
07702
US

V. Phone/Fax

Practice location:
  • Phone: 732-229-3344
  • Fax: 732-728-0870
Mailing address:
  • Phone: 732-229-3344
  • Fax: 732-728-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KEITH MAZANOWSKI
Title or Position: PRESIDENT
Credential:
Phone: 732-229-3344