Healthcare Provider Details

I. General information

NPI: 1699004606
Provider Name (Legal Business Name): SOMC MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W COUNTY LINE RD
JACKSON NJ
08527-2267
US

IV. Provider business mailing address

1200 JUMPING BROOK RD BUILDING 5
NEPTUNE NJ
07753-2634
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-3881
  • Fax:
Mailing address:
  • Phone: 732-643-4321
  • Fax: 732-481-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNJ

VIII. Authorized Official

Name: CARL MARCHETTI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-643-4312