Provider Demographics
NPI:1225115066
Name:MEDICAL ASSOCIATES OF FREEHOLD LLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF FREEHOLD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:HAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-462-1036
Mailing Address - Street 1:27 WILDHEDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2115
Mailing Address - Country:US
Mailing Address - Phone:732-946-7249
Mailing Address - Fax:732-946-2540
Practice Address - Street 1:1 APPLEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5309
Practice Address - Country:US
Practice Address - Phone:732-946-7249
Practice Address - Fax:732-946-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherHORIIZON BLUE CROSS/BLUE SHIELD
=========OtherHORIIZON BLUE CROSS/BLUE SHIELD