Provider Demographics
NPI:1417018292
Name:MONMOUTH MEDICAL ASSOCIATION PC
Entity Type:Organization
Organization Name:MONMOUTH MEDICAL ASSOCIATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-229-3344
Mailing Address - Street 1:450 SHREWSBURY PLAZA
Mailing Address - Street 2:SUITE 291
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-229-3344
Mailing Address - Fax:732-728-0870
Practice Address - Street 1:285 PARKER ROAD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:732-229-3344
Practice Address - Fax:732-728-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty