Healthcare Provider Details

I. General information

NPI: 1083164305
Provider Name (Legal Business Name): MERIDIAN MEDICAL GROUP-PEDIATRIC UROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 JUMPING BROOK RD BLDG 5
NEPTUNE NJ
07753-2634
US

IV. Provider business mailing address

557 CRANBURY RD SUITE 4
EAST BRUNSWICK NJ
08816-5419
US

V. Phone/Fax

Practice location:
  • Phone: 732-902-7000
  • Fax: 732-481-8464
Mailing address:
  • Phone: 732-613-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH SABLE
Title or Position: PRESIDENT AND TREASURER
Credential: M.D.
Phone: 732-776-4900