Healthcare Provider Details

I. General information

NPI: 1467642736
Provider Name (Legal Business Name): AFFILIATED MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E FRONT ST
KEYPORT NJ
07735-1562
US

IV. Provider business mailing address

PO BOX 27
KEYPORT NJ
07735-0027
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-7222
  • Fax: 732-264-4143
Mailing address:
  • Phone: 732-264-7222
  • Fax: 732-264-4143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. ROSEMARY SHERMAN
Title or Position: CEO
Credential:
Phone: 732-264-7222