Healthcare Provider Details

I. General information

NPI: 1053316695
Provider Name (Legal Business Name): JERSEY SHORE MONMOUTH COUNTY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 CORLIES AVE
NEPTUNE NJ
07753-4842
US

IV. Provider business mailing address

PO BOX 23958
NEWARK NJ
07189-0001
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-8789
  • Fax: 732-502-4435
Mailing address:
  • Phone: 732-263-7935
  • Fax: 732-263-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA19998
License Number StateNJ

VIII. Authorized Official

Name: MS. ANN DALTON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 732-775-8789