Provider Demographics
NPI:1255471306
Name:MONMOUTH COUNTY OFFICE ON AGING
Entity Type:Organization
Organization Name:MONMOUTH COUNTY OFFICE ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WANAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-431-7450
Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1255
Mailing Address - Country:US
Mailing Address - Phone:732-431-7450
Mailing Address - Fax:732-303-7649
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1255
Practice Address - Country:US
Practice Address - Phone:732-431-7450
Practice Address - Fax:732-303-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8053804Medicaid
NJ3053812Medicaid