Healthcare Provider Details

I. General information

NPI: 1023172236
Provider Name (Legal Business Name): MERIDIAN TRAUMA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

PO BOX 416754
BOSTON MA
02241-6754
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4949
  • Fax:
Mailing address:
  • Phone: 732-807-0800
  • Fax: 732-922-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES CLARKE
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-765-6317