Healthcare Provider Details

I. General information

NPI: 1639502057
Provider Name (Legal Business Name): TOTAL CARE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 HOOPER AVE
TOMS RIVER NJ
08753-8175
US

IV. Provider business mailing address

1868 HOOPER AVE
TOMS RIVER NJ
08753-8175
US

V. Phone/Fax

Practice location:
  • Phone: 732-451-1200
  • Fax: 732-864-1229
Mailing address:
  • Phone: 732-451-1200
  • Fax: 732-864-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JACKIE TATE
Title or Position: OFFIE MANAGER
Credential:
Phone: 732-451-1200