Healthcare Provider Details

I. General information

NPI: 1932647872
Provider Name (Legal Business Name): MMC PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

95 OLD SHORT HILLS RD
WEST ORANGE NJ
07052-1008
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-8000
  • Fax:
Mailing address:
  • Phone: 732-423-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MINTZ
Title or Position: DIR. FINANCE
Credential:
Phone: 732-423-7497