Healthcare Provider Details

I. General information

NPI: 1457356685
Provider Name (Legal Business Name): JERSEY SHORE PSYCHIATRIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 RTE 66 STE 5
NEPTUNE NJ
07753-2625
US

IV. Provider business mailing address

3535 RTE 66 BUILDING 5
NEPTUNE NJ
07753-2622
US

V. Phone/Fax

Practice location:
  • Phone: 732-643-4350
  • Fax: 732-643-4398
Mailing address:
  • Phone: 732-643-4350
  • Fax: 732-643-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA M BENNINGTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-643-4403