Healthcare Provider Details

I. General information

NPI: 1285937086
Provider Name (Legal Business Name): MONMOUTH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N BATH AVE
LONG BRANCH NJ
07740-6317
US

IV. Provider business mailing address

75 N BATH AVE
LONG BRANCH NJ
07740-6317
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-6500
  • Fax:
Mailing address:
  • Phone: 732-923-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number44SC05431200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2865X1600X
TaxonomyOperational (Transportable) Military General Acute Care Hospital
License Number44SC05431200
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD DIXON
Title or Position: DIRECTOR, OUTPATIENT MENTAL HEALTH
Credential: LCSW
Phone: 732-923-5222