Healthcare Provider Details

I. General information

NPI: 1144476771
Provider Name (Legal Business Name): NEPTUNE ADULT MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 CORLIES AVENUE
NEPTUNE NJ
07753
US

IV. Provider business mailing address

1812 CORLIES AVENUE
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-3336
  • Fax: 732-776-8668
Mailing address:
  • Phone: 732-988-3336
  • Fax: 732-776-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMA079626
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMA079626
License Number StateNJ

VIII. Authorized Official

Name: DR. KIMBERLY ATIENZA
Title or Position: PHYSICIAN
Credential: MD
Phone: 732-988-3336