Healthcare Provider Details

I. General information

NPI: 1790998805
Provider Name (Legal Business Name): ATLANTIC ENT ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 HIGHWAY 70 BUILDING 6B
MANASQUAN NJ
08736-2609
US

IV. Provider business mailing address

2640 HIGHWAY 70 BUILDING 6B
MANASQUAN NJ
08736-2609
US

V. Phone/Fax

Practice location:
  • Phone: 732-223-8686
  • Fax: 732-223-6572
Mailing address:
  • Phone: 732-223-8686
  • Fax: 732-223-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMB55529
License Number StateNJ

VIII. Authorized Official

Name: MRS. ROXANNE D HOFFMANN
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-223-8686