Healthcare Provider Details

I. General information

NPI: 1285078592
Provider Name (Legal Business Name): JFK MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 ROUTE 66 FL 3
NEPTUNE NJ
07753-2645
US

IV. Provider business mailing address

PO BOX 95000-7710
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 888-571-5280
  • Fax: 732-922-0914
Mailing address:
  • Phone: 888-571-5280
  • Fax: 732-922-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD C SMITH
Title or Position: CFO
Credential:
Phone: 732-321-7747