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
1 NPI 1598896912
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name PREVENTIVE MEDICINE OF MONMOUTH PC
5 Provider First Line Business Practice Location Address 555 SHREWSBURY AVE
6 Provider Business Practice Location Address City Name SHREWSBURY
7 Provider Business Practice Location Address State Name NJ
8 Provider Business Practice Location Address Postal Code 077024178
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 7322190894
11 Provider Business Practice Location Address Fax Number 7322190896
12 Provider Enumeration Date 3/8/2007
13 Last Update Date 10/1/2008
14 Authorized Official Last Name ROSEN
15 Authorized Official First Name NEIL
16 Authorized Official Title or Position PRESIDENT
17 Authorized Official Telephone Number 7322190894
18 Healthcare Provider Taxonomy Code 1 207Q00000X
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Other Provider Identifier 1 568074
21 Other Provider Identifier Type Code 1 04
22 Other Provider Identifier State 1 NJ
23 Is Organization Subpart N
24 Authorized Official Credential Text D.O.
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
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.