Healthcare Provider Details

I. General information

NPI: 1538336359
Provider Name (Legal Business Name): SR CAMPUS PRIMARY CARE PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ESSEX RD
TINTON FALLS NJ
07753-2631
US

IV. Provider business mailing address

701 MAIDEN CHOICE LN
BALTIMORE MD
21228-5968
US

V. Phone/Fax

Practice location:
  • Phone: 732-643-2070
  • Fax: 732-643-2015
Mailing address:
  • Phone: 410-402-2258
  • Fax: 410-402-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNJ

VIII. Authorized Official

Name: MATTHEW J NARRETT
Title or Position: EXECUTIVE VP CHIEF MEDICAL OFFICER
Credential: MD
Phone: 410-402-2258