Healthcare Provider Details

I. General information

NPI: 1821445594
Provider Name (Legal Business Name): JSR MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 STATE HIGHWAY 36 SUITE 5
WEST LONG BRANCH NJ
07764
US

IV. Provider business mailing address

214 STATE HIGHWAY 36 SUITE 5
WEST LONG BRANCH NJ
07764
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-8000
  • Fax: 732-963-2246
Mailing address:
  • Phone: 732-222-8000
  • Fax: 732-263-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMA04782100
License Number StateNJ

VIII. Authorized Official

Name: JOEL ROSS
Title or Position: OWNER
Credential: MD
Phone: 732-222-8000