Healthcare Provider Details

I. General information

NPI: 1134268683
Provider Name (Legal Business Name): MONMOUTH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

44 BARUCH DR
LONG BRANCH NJ
07740-7218
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-6635
  • Fax: 732-923-7724
Mailing address:
  • Phone: 732-923-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00077600
License Number StateNJ

VIII. Authorized Official

Name: MS. SHIRLEY HWANG
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: AOCNS
Phone: 732-923-6576