Healthcare Provider Details

I. General information

NPI: 1760438030
Provider Name (Legal Business Name): JERSEY SHORE MONMOUTH FAMILY MEDICINE GROUP P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 ROUTE 9
FREEHOLD NJ
07728-3258
US

IV. Provider business mailing address

3499 ROUTE 9
FREEHOLD NJ
07728-3258
US

V. Phone/Fax

Practice location:
  • Phone: 732-625-3166
  • Fax: 732-409-7473
Mailing address:
  • Phone: 732-625-3166
  • Fax: 732-409-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: JOHN GUMINA
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-625-3166