MEDICARE: SOMC MEDICAL GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist		NJ
2	207R00000X	Internal Medicine Physician		NJ

General Provider Information

NPI Number	:	1699004606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMC MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	1200 JUMPING BROOK RD
Second Line	:	BUILDING 5
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-2634
Country	:	US
Telephone Number	:	732-643-4321
Fax Number	:	732-481-8519

Provider Business Practice Location Address
First Line	:	2290 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2267
Country	:	US
Telephone Number	:	732-364-3881
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARL MARCHETTI
Credential	:	M.D.
Telephone Number	:	732-643-4312

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	07/16/2014

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