Healthcare Provider Details

I. General information

NPI: 1265724264
Provider Name (Legal Business Name): DIVING AND HYPERBARIC MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W JEROME AVE
LONG BEACH TOWNSHIP NJ
08008-3211
US

IV. Provider business mailing address

1140 ROUTE 72 W
MANAHAWKIN NJ
08050-2412
US

V. Phone/Fax

Practice location:
  • Phone: 609-857-1436
  • Fax:
Mailing address:
  • Phone: 609-857-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA08386100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number25MA08386100
License Number StateNJ

VIII. Authorized Official

Name: DR. MATTHEW SEAMUS PARTRICK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 609-857-1436