MEDICARE: JERSEY SHORE MONMOUTH FAMILY MEDICINE GROUP P C

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	207R00000X	Internal Medicine Physician		NJ
2	207Q00000X	Family Medicine Physician		NJ

General Provider Information

NPI Number	:	1760438030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERSEY SHORE MONMOUTH FAMILY MEDICINE GROUP P C

Provider Business Mailing Address
First Line	:	3499 ROUTE 9
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-3258
Country	:	US
Telephone Number	:	732-625-3166
Fax Number	:	732-409-7473

Provider Business Practice Location Address
First Line	:	3499 ROUTE 9
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-3258
Country	:	US
Telephone Number	:	732-625-3166
Fax Number	:	732-409-7473

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOHN GUMINA
Credential	:	M.D.
Telephone Number	:	732-625-3166

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	11/16/2010

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