Provider Demographics
NPI:1205214277
Name:MONETTE TRESVALLES MD LLC
Entity Type:Organization
Organization Name:MONETTE TRESVALLES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRESVALLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-716-1000
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 D LACEY ROAD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-716-1000
Practice Address - Fax:732-716-1900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONETTE TRESVALLES MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-11
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06653400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty