Healthcare Provider Details

I. General information

NPI: 1295777605
Provider Name (Legal Business Name): EAST COAST INFERTILITY AND IVF P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SHREWSBURY AVE STE 300
SHREWSBURY NJ
07702-4151
US

IV. Provider business mailing address

655 SHREWSBURY AVE STE 300
SHREWSBURY NJ
07702-4151
US

V. Phone/Fax

Practice location:
  • Phone: 732-758-6511
  • Fax: 732-758-6511
Mailing address:
  • Phone: 732-758-6511
  • Fax: 732-758-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05329400
License Number StateNJ

VIII. Authorized Official

Name: MIGUEL DAMIEN
Title or Position: PRESIDENT
Credential:
Phone: 732-758-6511