Healthcare Provider Details

I. General information

NPI: 1225967524
Provider Name (Legal Business Name): SENTINEL MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 ROUTE 47 SOUTH UNIT WU-N, 2ND FLOOR
RIO GRANDE NJ
08242
US

IV. Provider business mailing address

1304 ROUTE 47 SOUTH UNIT WU-N, 2ND FLOOR
RIO GRANDE NJ
08242
US

V. Phone/Fax

Practice location:
  • Phone: 609-231-4292
  • Fax: 609-438-7944
Mailing address:
  • Phone: 609-231-4292
  • Fax: 609-438-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON CHRISTOPHER GRAHAM
Title or Position: OWNER
Credential: GRAHAM
Phone: 609-231-4292