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General NPI Number Information
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NPI Number | 1144476771
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Entity Type | Organization
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Legal Business Name | NEPTUNE ADULT MEDICINE LLC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 1812 CORLIES AVENUE
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City | NEPTUNE
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State | NJ
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Zip | 07753
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Country | US
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Telephone | 732-988-3336
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Fax | 732-776-8668
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Provider Business Mailing Address
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Address Line | 1812 CORLIES AVENUE
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City | NEPTUNE
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State | NJ
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Zip | 07753
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Country | US
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Telephone | 732-988-3336
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Fax | 732-776-8668
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KIMBERLY ATIENZA
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Credential | MD
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Telephone | 732-988-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MA079626
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MA079626
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License Number State | NJ
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