Provider Demographics
NPI:1073642401
Name:JERSEY SHORE MEDICAL AND PEDIATRICS ASSOCIATES,LLC
Entity Type:Organization
Organization Name:JERSEY SHORE MEDICAL AND PEDIATRICS ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:TALAMAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-942-0888
Mailing Address - Street 1:1215 HIGHWAY 70
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5947
Mailing Address - Country:US
Mailing Address - Phone:732-942-0888
Mailing Address - Fax:732-942-1230
Practice Address - Street 1:1215 HIGHWAY 70
Practice Address - Street 2:SUITE 1005
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5947
Practice Address - Country:US
Practice Address - Phone:732-942-0888
Practice Address - Fax:732-942-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070826207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH17834Medicare UPIN