Provider Demographics
NPI:1073558391
Name:MONMOUTH FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:MONMOUTH FAMILY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-413-2020
Mailing Address - Street 1:270 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-7027
Mailing Address - Country:US
Mailing Address - Phone:732-923-7100
Mailing Address - Fax:732-923-7104
Practice Address - Street 1:270 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7027
Practice Address - Country:US
Practice Address - Phone:732-923-7100
Practice Address - Fax:732-923-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23104261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032361Medicaid
NJ311845Medicare Oscar/Certification
NJ080954Medicare PIN