Healthcare Provider Details

I. General information

NPI: 1942362587
Provider Name (Legal Business Name): MERIDIAN MEDICAL GROUP - SPECIALTY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/02/2025
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

IV. Provider business mailing address

PO BOX 95000-7725
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 732-807-0800
  • Fax: 732-922-0548
Mailing address:
  • Phone: 732-807-0800
  • Fax: 732-922-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: JAMES CLARKE
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-807-0800