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General NPI Number Information
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NPI Number | 1922150358
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Entity Type | Organization
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Legal Business Name | MONMOUTH ADVANCED MEDICINE LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 503 STILLWELLS CORNER RD
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-308-0099
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Fax | 732-308-0347
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Provider Business Mailing Address
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Address Line | 503 STILLWELLS CORNER RD
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-308-0099
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Fax | 732-308-0347
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN MARC ZODKOY
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Credential | D.C.
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Telephone | 732-308-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00271700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 38MC00395200
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License Number State | NJ
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