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General NPI Number Information
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NPI Number | 1962635532
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Entity Type | Organization
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Legal Business Name | MONETTE M. TRESVALLES, MD, LLC
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 65 LACEY RD STE D
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City | WHITING
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State | NJ
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Zip | 08759-2985
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Country | US
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Telephone | 732-716-1000
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Fax | 732-716-1900
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Provider Business Mailing Address
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Address Line | 1749 ROLLING RIDGE LN
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City | TOMS RIVER
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State | NJ
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Zip | 08755-1005
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Country | US
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Telephone | 732-716-1000
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Fax | 732-716-1900
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Authorized Official
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Title or Position | OWNER
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Name | DR. MONETTE M. TRESVALLES
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Credential | MD
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Telephone | 732-716-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MA66534
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License Number State | NJ
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