Provider Demographics
NPI:1578989935
Name:MONMOUTH BEHAVIORAL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MONMOUTH BEHAVIORAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISTER-ALDAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-456-5394
Mailing Address - Street 1:3 CORBETT WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 CORBETT WAY
Practice Address - Street 2:SUITE B
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2283
Practice Address - Country:US
Practice Address - Phone:848-456-5394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPROUT HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-10
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory