Provider Demographics
NPI:1508848599
Name:MONMOUTH-OCEAN NEUROLOGY PC
Entity Type:Organization
Organization Name:MONMOUTH-OCEAN NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-774-8282
Mailing Address - Street 1:1944 CORLIES AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4862
Mailing Address - Country:US
Mailing Address - Phone:732-774-8282
Mailing Address - Fax:732-774-6816
Practice Address - Street 1:1944 CORLIES AVE
Practice Address - Street 2:STE 206
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4862
Practice Address - Country:US
Practice Address - Phone:732-774-8282
Practice Address - Fax:732-774-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6472605Medicaid
NJ532538Medicare UPIN