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General NPI Number Information
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NPI Number | 1578508297
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE OF MIDDLETOWN, LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1 RIVERVIEW PLZ
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City | RED BANK
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State | NJ
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Zip | 07701-1864
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Country | US
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Telephone | 732-720-9548
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Fax | 201-501-8502
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Provider Business Mailing Address
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Address Line | 8 MULBERRY LN
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City | ATLANTIC HIGHLANDS
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State | NJ
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Zip | 07716-2246
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Country | US
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Telephone | 732-720-9548
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Fax | 201-501-8502
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | GARY KERSHNER
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Credential | D.O.
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Telephone | 732-720-9548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB07312400
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License Number State | NJ
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