Healthcare Provider Details

I. General information

NPI: 1790726628
Provider Name (Legal Business Name): MONMOUTH PEDIATRIC GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 BROAD ST
RED BANK NJ
07701-2003
US

IV. Provider business mailing address

272 BROAD ST
RED BANK NJ
07701-2003
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-0456
  • Fax: 732-219-9477
Mailing address:
  • Phone: 732-741-0456
  • Fax: 732-219-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILLIAM WASSEL
Title or Position: PARTNER
Credential: MD
Phone: 732-741-0456