Healthcare Provider Details

I. General information

NPI: 1396793907
Provider Name (Legal Business Name): MERIDIAN OBSTETRICS AND GYNECOLOGY ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 ROUTE 33 SUITE A
NEPTUNE NJ
07753-3036
US

IV. Provider business mailing address

PO BOX 416824
BOSTON MA
02241-6824
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-7944
  • Fax: 732-922-8264
Mailing address:
  • Phone: 732-897-7944
  • Fax: 732-922-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARL MARCHETTI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-643-4312