PREVENTIVE MEDICINE OF MONMOUTH PC - NPI NUMBER 1598896912

Summary

Provider Name: PREVENTIVE MEDICINE OF MONMOUTH PC

NPI Number: 1598896912

Clasification: Family Medicine (207Q00000X)

Address:
555 SHREWSBURY AVE
SHREWSBURY, NJ
ZIP 07702

Phone Number: (732) 219-0894



Detailed Information

PREVENTIVE MEDICINE OF MONMOUTH PC is a family physician in Shrewsbury, NJ. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1598896912 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

555 SHREWSBURY AVE
SHREWSBURY, NJ
ZIP 07702-178
Phone: (732) 219-0894
Fax: (732) 219-0896

The provider's authorized official is Neil Rosen .
The authorized official title is President and has the following contact phone number (732) 219-0894.

The enumeration date for this NPI number is 3/8/2007 and was last updated on 10/1/2008.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207Q00000X Family Medicine Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 568074 MEDICARE ID-TYPE UNSPECIFIED NJ

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1598896912 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
4 Provider Organization Name Legal Business Name PREVENTIVE MEDICINE OF MONMOUTH PC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 555 SHREWSBURY AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name SHREWSBURY The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name NJ The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 077024178 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 7322190894 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 7322190896 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 3/8/2007 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 10/1/2008 The date that a record was last updated or changed.
14 Authorized Official Last Name ROSEN The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name NEIL The first name of the authorized official.
16 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
17 Authorized Official Telephone Number 7322190894 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 207Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Other Provider Identifier 1 568074 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
21 Other Provider Identifier Type Code 1 04 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
22 Other Provider Identifier State 1 NJ
23 Is Organization Subpart N Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Authorized Official Credential Text D.O. Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.