Healthcare Provider Details

I. General information

NPI: 1497710578
Provider Name (Legal Business Name): JERSEY SHORE NAVESINK PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 HIGHWAY 35
RED BANK NJ
07701-5908
US

IV. Provider business mailing address

PO BOX 23685
NEWARK NJ
07189-0001
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6677
  • Fax: 732-530-2946
Mailing address:
  • Phone: 732-842-6677
  • Fax: 732-530-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: CARL MARCHETTI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-842-6677