Healthcare Provider Details

I. General information

NPI: 1689135402
Provider Name (Legal Business Name): MONMOUTH MEDICAL ASSOCIATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W KENNEDY BLVD
LAKEWOOD NJ
08701-1255
US

IV. Provider business mailing address

721 W KENNEDY BLVD
LAKEWOOD NJ
08701-1255
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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