Healthcare Provider Details

I. General information

NPI: 1578807517
Provider Name (Legal Business Name): GARDEN STATE MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ROUTE 70
WHITING NJ
08759-1003
US

IV. Provider business mailing address

PO BOX 397
WHITING NJ
08759-0397
US

V. Phone/Fax

Practice location:
  • Phone: 732-849-0077
  • Fax:
Mailing address:
  • Phone: 732-849-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DHARAM MANN
Title or Position: PROVIDER
Credential: M.D.
Phone: 732-849-0077