Healthcare Provider Details

I. General information

NPI: 1962534404
Provider Name (Legal Business Name): MARY NOBLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 STATE ROUTE 36 BLDG E MONMOUTH PARK CORPORATE CENTER 1
WEST LONG BRANCH NJ
07764-1341
US

IV. Provider business mailing address

185 STATE ROUTE 36 BLDG E MONMOUTH PARK CORPORATE CENTER 1
WEST LONG BRANCH NJ
07764-1341
US

V. Phone/Fax

Practice location:
  • Phone: 866-598-5574
  • Fax: 732-229-2950
Mailing address:
  • Phone: 866-598-5574
  • Fax: 732-229-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMA50560
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: