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General NPI Number Information
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NPI Number | 1902092281
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Entity Type | Organization
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Legal Business Name | EATONTOWN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 117 STATE ROUTE 35
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City | EATONTOWN
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State | NJ
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Zip | 07724-1885
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Country | US
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Telephone | 732-542-4411
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Fax | 732-542-1070
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Provider Business Mailing Address
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Address Line | 117 STATE ROUTE 35
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City | EATONTOWN
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State | NJ
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Zip | 07724-1885
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. MANAR H HANNA
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Credential | MD
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Telephone | 732-542-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07738500
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License Number State | NJ
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