Healthcare Provider Details

I. General information

NPI: 1316720790
Provider Name (Legal Business Name): 140 MAIN STREET CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 11/09/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 HIGHWAY 35
SEA GIRT NJ
08750-1009
US

IV. Provider business mailing address

2175 HIGHWAY 35
SEA GIRT NJ
08750-1009
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-2929
  • Fax: 732-974-2644
Mailing address:
  • Phone: 732-974-2929
  • Fax: 732-974-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FRANK FARIELLO
Title or Position: DIRECTOR
Credential: PHARM D
Phone: 732-974-2929