Healthcare Provider Details

I. General information

NPI: 1235420696
Provider Name (Legal Business Name): CENTRAL JERSEY NEWBORN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 RED FOX CT
SKILLMAN NJ
08558-1722
US

IV. Provider business mailing address

PO BOX 74
SKILLMAN NJ
08558-0074
US

V. Phone/Fax

Practice location:
  • Phone: 908-829-3465
  • Fax: 908-359-4036
Mailing address:
  • Phone: 908-829-3465
  • Fax: 908-359-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA50514
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMA50514
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTHONY JOSEPH MARINO JR.
Title or Position: MANAGING DIRECTOR
Credential: MD
Phone: 908-829-3465