Basic Information
Provider Information
NPI: 1306949862
EntityType: 2
ReplacementNPI:  
OrganizationName: PHYSICIANS OF MONMOUTH LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 733 N BEERS ST
Address2: STE L4
City: HOLMDEL
State: NJ
PostalCode: 077331528
CountryCode: US
TelephoneNumber: 7327390707
FaxNumber: 7327398533
Practice Location
Address1: 733 N BEERS ST
Address2: STE L4
City: HOLMDEL
State: NJ
PostalCode: 077331528
CountryCode: US
TelephoneNumber: 7327390707
FaxNumber: 7327398533
Other Information
ProviderEnumerationDate: 09/07/2006
LastUpdateDate: 04/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ENGEL
AuthorizedOfficialFirstName: MARK
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7327390707
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X  Y Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

ID Information
IDTypeStateIssuerDescription
724600505NJ MEDICAID


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