Healthcare Provider Details

I. General information

NPI: 1396881215
Provider Name (Legal Business Name): FARMINGDALE MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST
FARMINGDALE NJ
07727-1218
US

IV. Provider business mailing address

21 MAIN ST
FARMINGDALE NJ
07727-1218
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-7002
  • Fax: 732-751-9492
Mailing address:
  • Phone: 732-938-7002
  • Fax: 732-751-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06083500
License Number StateNJ

VIII. Authorized Official

Name: INA KELEMEN
Title or Position: OWNER
Credential: MD
Phone: 732-938-7002